Government Employees Medical Scheme [GEMS]
reviews and complaints

As a Type 1 diabetic with a chronic condition, relying on medication is not optional – it's a lifeline. Yet, GEMS has heartlessly denied and neglected my medication needs for over two months. Despite my countless calls and emails, they've callously ignored my pleas, pushing me to of running out of essential medication in just two days time from now. Their disregard for my health, their mistakes, and their obstinate refusal to even respond is an unforgivable betrayal. This level of negligence is not just disheartening; it's dangerous and life-threatening. My well-being shouldn't be subject to their indifference and incompetence.

We have submitted a letter for authorization on the 29th of September, and today, the 14th of October, 3 days prior to the operation, we still do not have feedback. Poor service from various custom care consultants, as well as a very rude lady on Authorization, by the name of Sonto Khuwsa refuses to assist and keep referring us to different departments.

We still do not have answers for our operation.

Rude people.

Good Day

I have been trying to enquire as to why a patients meds were not paid for. I have been on the line for 1hour and I have been put through to chronic dept, hosp auth dept, claims department but I couldn't get any assistance.

They have been paying this meds since 2017 and all of a sudden they decline with reason "DOH Auth declined -Clinical info required.

Patient Ms A Agenbag

Member nr [protected]

Service date 18/07/2022

Patient is on Vitamin D (Alfacalcidol)

Mrs I Koopman

Case manager

Helderberg Hospital

I am writing this in dire need for something to happen with regard to my current situation and hope this will land in the right hands.

I am a dependant member on GEMS and have recently been diagnosed with fibroids and need urgent surgery. Gems refuses to pay for any procedure and claim they want to investigate.

Last year they removed me from the medical aid without the main member, my mother knowing. I only realised very late while trying to get medicine that they removed me. My mother tried to have me put back but it took time and was only put back in January this year. Now they are using the fact that I was not on medical aid last year to not pay for my procedure. A reason we had nothing to do with, they are the ones that took me out without any agreement from the main member. So I'm sitting here with a medical condition without a solution.

Hoping to hear from someone who will help me with this because I need medical attention.

I have the following queries and require detailed explanation for each point below. I will be seeking legal advice on below points if this problem is not solved as a matter of priority:
- I received a letter this year in June 2017 stating: Contribution Reconciliation. Please explain detailed billing regarding this as the amount that I have over paid is stated as the amount that is in arrears.
- I have a medicine access card that states clearly that my chronic medication is approved and is due on the 30th of every month. This medication has not changed since this card has been given to me.
- My statement in January 2017 was R2178 and in February it was R2631, I presume this was an increase in the medical aid. I was never notified about any increase, if I would have been notified about this arrangement would have been made regarding the debit order that is taken off every month.
- I received a letter in September 2017 stating my account is in arrears of R5405, please explain how you got to this amount,
- According to my detailed statement my medical aid is as follows:
- Acute medication: R5642
- Chronic medication: R17 146
- Day to day limit: R1529.09
- Why do I receive a letter every month about my account being in arrears when a debit order goes off automatically
- I was NEVER notified about any increase regarding my medical aid going up
- I went for an MRI on the 15th of November 2016, which my medical aid has authorised, the authorisation number is [protected], and now you are refusing to pay this. This has been going on for longer than a year.
- My chronic medication is supposed to be paid by you as per my card approved by you. I have been paying this out of my own pocket since the beginning of this year (January 2017), yet I have statements where you guys have approved my chronic medication which I have paid out of my own pocket.
- Why is it approved some months and other months not?
- My account has been suspended since the beginning of this year, but yet you still taking money every month and I am paying everything out of my own pocket.
Thank you for your assistance regarding this matter. I have all documentation for points stated above, please advice if you will be needing this and I will gladly forward all documents required.

I Got medical proof from a specialist that my gums have severely infection, and have 2 sists to be removed in my gums and the only way to heal it is to draw my teeth and to put in dentures.
My dentures are already been made and the aid approve that.
Now I wonder how will they put in the dentures taht`s been made.

This is realy the worst medical aid that I`ve come across.
They don`t even give reasons why it is not approved.
They just say it is not approved.
I am very dissapointed we pay about R5000 a month and they are not prepaired to assist an any funds.

My medical aid no is Emerald [protected]. PC Becker

I am a teacher on pension and GEMS is the only Medical Aid I can be a member of. I was a while in the Middle East and since my return in June 2009 I couldn't be able to get a membership with GEMS. They told me to apply through the department of Treasury, I did, but was the end of GEMS! A month ago I had a thrombosis in my leg. I had to visit a clinic which cost me R100 plus per day. I can't see a specialist, I can't afford it without a medical aid. GEMS just don't answer me! What do I do?