Unclear Policy Changes and Disappointing Claims Service

Dear Medgap,

I am writing to formally request that Medgap reconsider the outcome of my three hospital admission claims, totalling R6,500 x 3 = R19,500.

I called Medgap on Friday, 4 September 2026, and was only then informed that my policy had been moved from Medgap to Bgap, with the consequence that I could no longer use a non-network hospital without facing a significant financial shortfall.

My concern is not simply the outcome of the claims, but how this change was communicated to me as a client.

I acknowledge that a letter was sent to me. However, this was sent as what appeared to be a standard increase/renewal communication. There was no clear warning in bold, red, or otherwise prominent wording explaining that this was a significant change to my cover and that using a non-network hospital could result in a substantial co-payment.

Furthermore, terminology such as “non-DSP” was used. As a consumer and layperson, I should not be expected to automatically understand that this means a non-network hospital and, more importantly, that it could have such a significant financial consequence.

There was also no separate form requiring me to confirm whether I accepted the change, nor was I contacted by Medgap to explain the implications of the change. I do not have a broker who could have assisted me in understanding what this communication meant.

The communication was also sent around month-end/year-end, when people are busy with their personal and professional commitments. A change that materially affects the benefits and financial protection provided by a gap cover policy should, in my view, have been communicated in a much clearer and more prominent manner.

I have been a Medgap client since 2023 and have paid my premiums consistently. I therefore reasonably believed that I had the level of protection I had when I took out the policy.

What makes this situation even more concerning is my previous experience with Medgap's claims administration.

On two previous occasions, I experienced problems where claims were incorrectly processed despite your employees being trained to deal with these matters.

For example, in 2023, I submitted a hospital admission claim. The claim was rejected and I was simply referred to pages 19 and 20 of the policy documentation. When I queried the matter again in 2025, after another hospital admission claim was paid, I was informed that the original 2023 claim had been incorrectly captured by a staff member. The claim was subsequently paid, approximately two years later.

This demonstrates that mistakes can and do happen on the administration side, even with trained employees.

I also experienced an issue with Bonitas in 2022 when I submitted documentation relating to my son. Despite the information being correctly completed, the documentation referred to him as an “adopted son”, which was incorrect. Again, this required additional clarification and follow-up from my side.

I therefore find it extremely unfair that, as the consumer, I was expected to understand the full implications of a single letter containing industry terminology, without a clear explanation, separate notification, or confirmation process — while Medgap's own employees have previously made errors when processing my claims.

If consumers are expected to carefully understand every technical term and implication in policy correspondence, then surely the same standard of accuracy and clarity should apply when claims are being processed.

I also understand that I am not the only client who was unaware of this change. I have spoken to a colleague whose parents were similarly unaware of the change, and they will also be contacting Medgap regarding the matter.

I have been with Medgap for approximately three years. During this relatively short period, I have experienced two instances where claims or documentation were incorrectly handled, requiring numerous calls, emails and follow-ups from my side. I am now facing a further situation where a major change to my cover was, in my opinion, not adequately communicated.

This has left me extremely disappointed with the level of service provided.

I have been with other service providers for significantly longer periods and have never experienced this level of difficulty when dealing with my cover or claims.

I therefore respectfully request that Medgap reconsider all three hospital admission claims.

The total amount at issue is:

R6,500 x 3 = R19,500

I am asking Medgap to please exercise discretion and reconsider these claims in light of the circumstances surrounding the change in cover and the manner in which it was communicated.

If Medgap is unable to approve the full amount, I would even ask that you consider a 50% settlement of the three claims, as a goodwill resolution.

I have continued paying my premiums for the past eight months believing that I was receiving the protection I had originally signed up for. I understand that policies can change, but consumers should be given a clear, meaningful opportunity to understand and accept significant changes to their cover.

I was not given a choice to actively accept this change, nor was the significance of the change clearly explained to me.

I therefore plead with Medgap to look at this matter from the perspective of a long-standing paying client and reconsider the claims fairly and reasonably.

I would appreciate a formal written response explaining the outcome of your reconsideration and the basis for the decision.

I sincerely hope Medgap will take the circumstances into account and find a fair resolution.