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Dispute Resolution

The rules of the scheme make provision for GEMS members, healthcare providers and third parties who’d like to assist a member to lodge a complaint against the Scheme. The parties mentioned above may lodge a complaint through any of the bellow channels:

Post: GEMS, Private Bag X782, Cape Town, 8000
Email: Complaints@gems.gov.za
Call centre: 0860 00 4367
Fax: 0861 00 4367

If you use these channels to lodge a complaint it ensures that the scheme responds promptly. The scheme will respond within 48 hours after receiving the complaint, however, some complaints need clinical input and investigation, and these would 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.

See our dispute resolution guide and referral form below:
Guide to the GEMS dispute resolution procedure
GEMS dispute committee referral form

 

 

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

 

Dispute Resolution Guide and Referral Form: