BM
Bertha M

1 reviews | Active since Apr 2018

24 Apr 2018, 15:20

Unjustified waiting periods imposed

I am very disappointed and absolutely disturbed by the treatment received from Gems medical aid, after being part of the scheme for more than 10 years paying them every month without fail and not once claiming on hospitalization. I get a hefty bill of R8 433.15 and another one for R1534.50 on medical bills for my daughter who has been a depended on the scheme. She was terminated last year 30 September 2017 we than send an application on 29 November 2017 which is exactly two months later. We were given a waiting period of three months of which we could not claim at all as well as 12 months period for pre-existing conditions. According to the medical aid act 90 day rule she should still have full cover as 90 days have not lapsed between when the cover was terminated and when we reapp****.

I would like to know why she was not covered for three months and also why she cannot claim for so called pre-existing condition for 12 months?

Application was sent on 29 November2017 we were only given feedback in January 2018 regarding the status of her application and are being informed that its more than 90 days? She has been calling the call centre for two days and no one can explain to her, she was put on hold for hours, calls are being dropped. She has had no joy in dealing with your call centre staff.

Call References Call Reference 1: Tebogo, 24 April 2018 at 12:32 Call Reference 2: MH ********** 1, Molebogeng, 24 April 2018 at 12:54 Call Reference 3: MH ********** 6, Queen Titus and her supervisor Bernice, 24 April 2018 at 12:57 Call Reference 4: 241684, Elizabeth, 24 April 2018 at 14:02

Bertha Mahlangu ********** 630

0
Replies (3)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply24 Apr 2018, 17:31
Official

Good day

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

Kind regards

The GEMS online

BM
Bertha M's update30 Apr 2018, 12:57
Reviewer Update
It is 5 days since the post was made, I have not heard a word from Gems. The lack of communication is unbelievable. I am angry and frustrated at their lack of service. Can someone please contact me as a matter of urgency.
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply03 May 2018, 15:03
Official

Good day

Thank you for alerting us to your concerns regarding your membership application.

Please note that in order for the application to be finalised, all the pages of the application form should be initialed and fully signed. Once all the pages have been initialed and signed, please resubmit your application to [email protected]o.za.

We look forward to being of service to you.

Kind regards

The GEMS online team