NJ
Nicollette J

1 reviews | Active since Jul 2022

18 Feb 2026, 17:48

No sense of emergency to a rejected claim

This medical scheme just doesn’t care about the well being of their patients/clients, you’ll Pay thousands at the end of each month out of your own pocket as they will always come with excuses not to pay claims and find lousy excuses as to why they won’t pay the doctors even if it’s their own consultants who gave you the assurance that it will be paid as the benefits / funds are there , I called this scheme twice before going to my antenatal check up and scan to get assurance it will be covered and I was told yes but guess what they are coming with lousy excuses not to pay , mind you they don’t care that I’m pregnant and the stress this is putting me and my unborn baby under , I’ve called multiple times spoke to managers but the issue I have with them is still not solved and I’ve been patient , I waited the days I was told to wait for the case to be looked into , I had to call back to find out if it was resolved and it wasn’t , I guess the scheme is telling me it’s not important that I won’t see my doctor this month as I can’t consult unless the funds are paid , my well being is not priority to a medical scheme and they keep on proving this to me daily , jokes are on me and my mother who kept encouraging her colleagues that gems is good while they warned us it’s not, I’m on Emerald and someone I know who is on Ruby got the same scan at the same weeks and it was paid but me to who pays more it was rejected , make that make sense please , don’t go with gems rather look for another scheme they’ll stress you out

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply19 Feb 2026, 10:01
Official
Good day,

Thank you for engaging with us.  We are following your message, and feedback will be provided. If you have an urgent query, please contact us on  ***(members Toll-free number) & ***(providers).

Call Centre Hours: Monday - Friday: 8h00 - 17h00 & Saturday: 8h00 - 12h00.

 Emergency number: ***(available 24 hours)

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We look forward to receiving your positive feedback. 

Regards, GEMS 
NJ
Nicollette J's update20 Feb 2026, 13:46
Reviewer Update
Thank you to Michelle ( manager ) from maternity dept for her patience and great customer service, she escalated the matter and was very patient with me and understood my frustrations and concerns, although it took a while for her to get feed back from claims dept she called and apologised and informed me that she managed to explain that I was within the weeks required to get a scan and it should be paid and it was paid , she also has a great team with her , midwife Tshimangadzo and Jimmy , they were all of great help and were very patient with me and also helped to explain the maternity benefits so we dont get such issues again, I still say Gems can do better but with a great team like the persons mentioned above they can be given a second chance