GEMS Medical Aid

gems medical aid

When it was first introduced 6 years ago, GEMS (Government Employee Medical Scheme) had one chief objective; to significantly boost the number of South African workers who could access affordable healthcare, enabling them to continue contributing to the country’s growth for longer. And looking at the figures, the organisation seems to have exceeded its objectives by far.

Over half a million government employees are enrolled with GEMS, with another 74,000 having joined in 2011. And through these memberships, more than 1.5 million South Africans have gained access to quality health services. Though it began offering services to the public in 2006, GEMS actually began life as a policy approved in 2002 by the cabinet. This piece of legislation was aimed at levelling the playing field in terms of the distribution of basic healthcare services as well as ensuring they were delivered efficiently.

Benefits accruing to government employees who are under this state-driven medical cover are numerous. Subscribers to the GEMS scheme have access to over 12,000 healthcare providers including GPs, dentists, ENT specialists, ophthalmologists and psychologists while making contributions that are far from strenuous. And in case you, as a member of GEMS are involved in an accident or any other incident requiring emergency medical attention, your cover will help ensure you receive the care you need. The GEMS cover also makes life easier for HIV patients, enabling them to confidentially obtain specialised care. GEMS’s devotion to the needs of employees saw it garner top ranking in the 2011 Ask Afrika Orange Index prize for customer care in the medical services category. Members are more than just ‘cases’ or ‘files’ to this organisation; they are treated with the utmost courtesy and respect.

GEMS flavours

Depending on their income levels, workers have 5 options they can choose from in terms of the level of care and nature of services they can afford. The most basic plan is Sapphire while Onyx gives members access to a greater array of services by specialised providers. In between these we have three other classes of schemes; Beryl, Emerald and Ruby. These provide different levels of care from different institutions that are above the entry level but below the top-of-the-range services of Onyx. Of course the monthly contributions vary according to the plan you sign up for. A Sapphire member holder earning a maximum of R5,710 will contribute roughly 10% of his earnings while an holder of Onyx GEMS membership will pay something over 20%. For this extra contribution, however, Onyx members can look forward to specialised care programmes for chronic maladies. Speaking of contributions, all GEMS subscribers can rest in the assurance that of the money they render to the scheme every month, only 6.2% goes into expenses not related to health care. This is quite literally less than half the industry average. It is a step aimed at making GEMS packages more affordable and ensuring that contributors get better value for their money.

And things will get better for GEMS members in 2012 with increased limits for both in and out-patient treatment. Even institutions listed as friends of GEMS stand to benefit from a higher increase in professional fees as compared to those who are not part of the GEMS network.