*********** staff- gap cover claims

1. Despite assurances that I would be contacted by your claims team, the communication has been inconsistent, delayed, and largely automated. This has caused unnecessary stress and confusion during an already difficult time. 2. I understand that claim assessments can be complex, but the lack of clear guidance and support from your side has left me without the assistance that GAP cover is meant to provide. The onus seems to be placed entirely on me to dispute rejections with the medical aid and providers, which defeats the purpose of having GAP cover in the first place. 3. I find it particularly concerning that multiple claims were rejected based on technicalities such as “lack of authorization” or “scheme rules not followed.” As a member, I rely on GAP cover to protect me from these very shortfalls, and I expected your team to assist in engaging with providers and the scheme to resolve discrepancies, rather than simply passing responsibility back to me. 4. The communication that “the majority of claims are likely to be rejected” is unacceptable. This statement, without clear explanations and proactive support, undermines the value of the cover I have faithfully paid for. Given the above, I request the following: • A full, line-by-line breakdown of all rejected claims, with a plain-language explanation of the reason for each rejection. • Assistance from your team in engaging with Medihelp and the providers to resolve matters where authorisations or motivations can still be obtained. • A clear outline of what next steps I need to take, with your direct guidance and support, rather than generic instructions.