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
Sapphire is the entry-level option. You can qualify for a 100% employer subsidy. It offers in and out of hospital benefits. It offers maternity care at private hospitals. If you use the GEMS allocated list of doctors or medicines there are no co-payments. Also covered are your dentist and optometrist visits.
The Beryl option offers comprehensive in and out of hospital benefits. The network doctors or hospital are still available for use. You are allowed 3 General practitioner visits that are not nominated, however, you will have to pay a co-payment. Your contributions are salary based. Specialist treatments must be referred by your general practitioner and approved first.
This is a comprehensive in and out of hospital benefit scheme. It offers a Personal Medical Savings Account, a hospital plan and a block benefit. The savings account is set to be a percentage of your contribution that is held in a savings account in your name. this pays for your day-to-day medical expenses and your out-of-hospital expenses. Once you have exhausted this savings account, your claims will be paid by the limited Block Benefit. The premiums here too are salary based.
The Emerald cover offers you comprehensive cover on both in and out of hospital benefit, provided that you use a nominated General Practitioner and hospital for their specified list. If you used a private general practitioner you will be liable for a co-payment.
The Onyx is the top of the range extensive cover. This includes extensive in and out of hospital benefits. This also covers your hospital visit, MRI Scans, CT Scans, in hospital physiotherapy and specialized dentistry needs. Premiums are salary based.
GEMS does not cover operations for cosmetic purposes or alternative therapy treatments.
GEMS has a workplace Fitness programme. The benefits are access to themed workshops and exercise sessions at your workplace. There are interdepartmental exercise challenges. There are Fitness assessments, desk exercises, access to Health coaches via telephone or on site.
NEED MEDICAL AID?
Get multiple medical aid quotes now.