The rules of the scheme make provision for GEMS members, healthcare providers and third parties to lodge a complaint against the Scheme.
If a third party is assisting the main member please indicate that you are lodging a complaint on behalf of the main member and ensure that the member has given consent. The form is available on our website https://www.gems.gov.za/ which is under forms and named as beneficiary consent form (named as Consent form authorising GEMS to disclose personal information to a third party):
The parties mentioned above may lodge a complaint through any of the below channels:
Call Centre: 0860 0043 67
Post: GEMS, Private Bag X782, Cape Town, 8000
Fax: 0861 00 43 67
To ensure that we resolve your written complaint as speedily as possible, please remember the following:
• Add your membership number or your ID number in the subject line.
• Add all relevant details and also attach any supporting documents (if available).
• Add your contact number and email to ensure that we can contact you.
• Name of practice and practice number as well the service date, if available.
• The details of the claim being queried (if applicable).
The scheme will investigate the complaint and will respond within 7 working days after receiving the complaint, however, some complaints need clinical input and investigation, and these may take longer to resolve. We’d like to reassure our members, healthcare providers and third parties that you will always be informed about the status of your complaint and the scheme will ensure that the complaint is resolved as quickly and efficiently as possible.
If you’re not satisfied with the response that you get from us and all efforts to resolve the issue with the scheme are unsatisfactory, you can escalate your complaint with the scheme's Dispute Committee.
The Dispute Committee is an independent committee which ensures that disputes between the scheme and a complainant are resolved. The decision by the Dispute Committee is final and binding on the scheme.
If you’re still not satisfied with the decision of the Dispute Committee, then the matter can be referred to the Registrar of the Council for Medical Schemes (CMS) for further investigation .
Please note that If a complaint is submitted to the CMS before it has gone through the scheme's Dispute Committee, then the matter cannot be brought to GEMS’ Dispute Committee. It is therefore important that you lodge your complaint with the scheme before approaching the CMS.
Remember that your complaint is resolved by the scheme and the CMS at no cost to you.
Lodge a complaint with the Scheme via any of the following channels:
Post: GEMS, Private Bag X782, Cape Town, 8000
Email: Complaints@gems.gov.za
Call centre: 0860 00 4367
Fax: 0861 00 4367
