GEMS stands for Government Employees Medical Scheme. The medical aid is simple. You are covered for all the basic medical requirements provided that you use the dedicated general practitioner or hospital in that plans authorised list. There are no frills and fancies on this medical aid. Important to remember is that everything has to pre-approved to avoid penalties. There is a Wellness programme but it has to be approved by your department. Gems medical aid has five options
Plan ahead for a worry-free pregnancy.
The important thing to do, if you are planning to fall pregnant, is making sure you are on a medical aid first. Most will not provide cover if you fall pregnant before joining the scheme. This could result in you facing a large medical bill for treatment during pregnancy and the delivery or using public healthcare to reduce the costs.
Most medical aids in South Africa will provide expenses for checkups and treatment during your pregnancy, hospitalisation and delivery and some antenatal benefits. That is, provided you were on the plan before falling pregnant. Joining a plan after falling pregnant could mean you are subject to exclusions or a waiting period.
There are a number of widely believed myths about medical schemes in South Africa. This article will give you the truth behind the myths.
Myth: My applications can be turned down by a scheme
Provided you pay the monthly fees, the scheme cannot decline your application. They can implement a 12-month waiting period for specific conditions or a standard 3-month waiting period for all claims. They are also entitled to charge a late joining penalty.
Many of us are healthy and rarely get sick. This applies to individuals as well as families. What a pleasure to have good health but do not take it for granted. Even the healthiest people can suddenly be struck down with a serious illness or have a major injury or accident. Do not think it can’t happen to you or your family.
Sadly, government hospitals in South Africa suffer from a lack of funds, a lack of staff and a lack of equipment. Many of them try very hard but struggle to give good basic health care. If you can afford it, medical aid is not a luxury, it is essential.
There are a number of good reasons to join a medical aid and the sooner the better.
Caring for the health and comfort of those in their golden years is not always easy.
Pensioners find themselves face to face with some tough issues when it comes to medical aid. In many cases, the elderly have limited financial resources at their disposal at retirement and due to their age, they need medical care for any chronic or other conditions they may have as they get older.
Changes to the National Health Insurance (NHI) are going to happen. The final details are not yet cast in stone but a dramatic shift is imminent. By 2022, the NHI should be in full effect.
Some of the points are still being debated but the changes will have a dramatic effect on most South Africans.
It is extremely important that medical aid members understand co-payments in order to avoid costly surprises. Medical aid plans have to have limits in place to control their business, calculate monthly contributions and avoid abuse.Continue reading
Medical aid jargon can be pretty confusing to say the least…
In today's world, many of the most commonly used terms have been reduced to acronyms and other jargon. There is industry-specific jargon which can be confusing for the average citizen to fully understand, particularly when it comes to medical aid.
Having an understanding of the terminology will help you to better understand what each of them means. Let’s take a look at some of the more common ones.Continue reading
Medical aid companies receive many complaints. Often this stems from a lack of understanding of how the plan works.
Many people do not read the fine print until there is a dispute. The best bet is to study or have an independent broker explain the details of the plan to you.
That being said, there are defiantly some medical aid companies that offer better service than others.Continue reading