SM
Sindi M

1 reviews | Active since May 2017

04 May 2017, 01:38

Poor service

<p>I am appalled at the kind of service I have received from Gems.</p> <p>I was a dependent on my husband's Gems medical aid until August 2016. Around the 22 November 2016 I sent through an application for membership via ********** even received the automated response that my application had been received. However, it was never processed and after weeks of follow up was told to resend the application form which I did via a walk-in centre. On the 20th of December I received confirmation that I had been registered on the scheme. I then proceeded to register on the online portal and saw that a 3 month general waiting period had been app****.</p> <p>I then found out I was pregnant and then called the callcentre to inform Gems and to find out how that would affect my benefits. I was told by the callcentre agent that since my 3 month waiting period would have expired I will be covered for the birth & that at most I might have to pay a co-payment. I would also have to wait until the waiting period was over to register on the maternity programme.</p> <p>However to my utter disbelief, on the day the hospital was supposed to get authorisation for the admission there were suddenly issues I had not previously been informed about. On the very day that the request for authorisation was made, I was suddenly given a condition-specific waiting period which I was not previously there. Hence my request for authorisation has been rejected. I am suddenly left in a situation where I have no idea how I am to pay for the birth of my child at short notice because of the conflicting advice of the call centre agents. I made every attempt to inform Gems of my condition & a no point was I given an indication that I may find myself in this situation.</p> <p>I am not at all happy with the way Gems has handled my membership from the delay in processing my application down to the issue of getting authorisation. If the people who are supposed to give us the correct information themselves are ill-informed and not clear on the processes, what kind of service can we then be expected to get?</p>

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply04 May 2017, 10:26
Official

Good day

Thank you for affording us the opportunity to respond to your concerns. We are looking into this matter and will provide feedback.

Kind regards

The GEMS online team

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply22 Jun 2017, 08:59
Official

Good day

Thank you for alerting us to your membership concerns.

We can confirm that your membership was accepted with effect from 1 February 2017, with a three-month general waiting period and a 12 month waiting period on pre-existing conditions.

The Scheme received an account in March 2017 for the supervision of a normal pregnancy and this pregnancy was not disclosed to the Scheme.

Please note that the pregnancy therefore regrettably falls within the pre-existing conditions as a 12 month waiting period applies from 1 February 2017 until 31 January 2018.

We apologise for the delayed response and any inconvenience caused in this regard.

Kind regards

The GEMS online team