LODGING OF DISPUTE

I am using this platform because all other attempts to resolve my issue has FAILED. I complained to GEMS, using emails, telephone calls and via HelloPeter. I use HelloPeter as a last resort when I don't get a response from the company itself. I have now lodged a dispute. I used the email address provided by GEMS for disputes to be lodged. I didn't get any response, nor did I get a reference number for my dispute. So I am again lodging a dispute via Hellopeter and I hope that it reaches the correct department: Here is my dispute: DISPUTE GEMS

URGENT and MEDICAL EMERGENCY

URGENT DISPUTE: ******** Removal of Adult Dependent and Immediate Request for Reinstatement Without Waiting Periods Dear Sir / Madam, I write this email with extreme urgency and distress to formally dispute the removal of my adult son from my medical aid membership and to request his immediate reinstatement without the imposition of any waiting periods. Background and continuity of membership My son has been registered continuously as my dependent on my medical aid membership since 1 June 2017, for a period exceeding eight (8) uninterrupted years. He has always appeared as Dependent 02, and during this entire time, his benefits were accessed lawfully and without interruption. Throughout the years, whenever verification was required, your scheme contacted me directly to complete and return dependency confirmation forms. I comp**** fully on each occasion. At no stage was I advised that his dependency would lapse, expire, or require renewal by a specific deadline. Lack of notification and procedural failure In December 2025, my son was informed at a doctor’s visit that his membership had “expired”. This was the first time either of us became aware that he had allegedly been removed from my membership. I categorically state the following: • I received no written notice, email, letter, SMS, or telephonic communication advising that my son would be removed. • I received no request to renew or re-confirm his dependency prior to removal. • I received no notice of termination, nor reasons provided, as required by principles of administrative fairness. I formally request that the scheme produce written proof that I was informed in advance of the removal of my son from my membership. In the absence of such proof, the removal is procedurally unfair and ********. Proof of inclusion and reliance Further, in December 2025, I received official communication advising me of my increased monthly contribution for 2026 (R16,181 before subsidy). This quotation included ALL my dependants, which reasonably led me to believe that my son’s membership remained active. I re**** on this representation in good faith. Medical urgency and severe hardship My son suffers from trigeminal neuralgia, a severe and internationally recognised neurological condition often referred to as the “suicide disease” due to the extreme, debilitating pain it causes. He was diagnosed about 4 years after joining Gems. This condition: • Is chronic and pre-existing • Requires continuous medical management • Has already forced us to pay for consultations out of pocket I am a pensioner, and I simply cannot continue to fund his care privately. More importantly, any interruption in treatment places him at risk of serious bodily impairment, severe psychological distress, and potential loss of life. This situation constitutes a medical emergency, and the standard dispute resolution timeframe of 21–30 days is not reasonable in these circumstances. Objection to waiting periods and penalties I was advised that my son can only be re-added as a “new” dependent (now Dependent 06), subject to: • A 3-month general waiting period • A 12-month waiting period for pre-existing conditions • A late-joiner penalty I object strongly to the application of any waiting period. There has been no break in dependency, only an administrative removal without notice. Under the Medical Schemes Act and CMS rules, waiting periods are not applicable where there is continuous cover and no voluntary lapse by the member. While I do not accept fault, I am willing, to consider a penalty if deemed unavoidable. However, I cannot and will not accept waiting periods, as they are unjust, ******** in this context, and medically dangerous. Formal request I hereby request the following: 1. Immediate reinstatement of my son on my membership without any waiting periods 2. Recognition of continuous membership from 1 June 2017 3. Written reasons and proof of notification allegedly sent prior to his removal 4. Immediate authorisation of treatment for his trigeminal neuralgia 5. Escalation of this matter to the Principal Officer due to medical emergency Should this matter not be resolved urgently, I will have no option but to escalate it to the Council for Medical Schemes, including an application for urgent intervention, as well as pursue further legal remedies. I am not asking for special treatment. I never have in all my years with you. I only plead for fairness, humanity, and compliance with the law. I trust that the scheme will act responsibly and compassionately in this matter. Yours faithfully, Premilla Deonath Principal Member *** My phone number is ***