The Gem Medical Aid caters exclusively for the
medical cover needs of government employees in South Africa. The name Gem stands for "government employees
The scheme was brought into life in order to provide quality medical cover to all
employees at all levels of government; national, provisional and local. It furthermore aims to provide equal
benefits to lower income employees.
The scheme is therefore closed to the general
public but state pensioners are able to apply for membership, once again regardless of the level of government
where they were employed prior to retirement.
What Plans Does the Gems
Medical Scheme Offer?
There are five distinct plans that are
designed to meet the needs of very specific target groups:
1. The Sapphire
Plan Members of this plan are required to make use of a network of service providers that are under
contract with the scheme. This includes general practitioners, dentists, pharmacies and optometrists. If members
keep to this network, they are not required to pay a portion of the cost of treatment but if they stray from the
list they can be liable for the cost. Specialist services may only be sought after prior approval by the
2. The Beryl Plan As with the Sapphire
plan, members must make use of medical professionals that are part of the Gems network of approved service
providers. This plan, however, also makes provision for out-of-hospital cover, medication for chronic conditions,
dental benefits, oncology treatment, dental cover and it even offers full maternity
3. The Ruby Plan This plan includes a
medical savings plan that allows members to manage the cost of day-to-day medical care. Members also have full
access to the Gems Personal Healthcare Support team. The plan includes full in-hospital cover and medication for
chronic conditions are included. However, members must obtain approval from the scheme prior to hospitalization or
before specialist are consulted.
4. The Emerald Plan
This plan resembles the Ruby plan because members must still make use of the Gems network of approved service
providers and they have to obtain authorization before in-hospital benefits can be claimed. The difference is that
this plan also offers cover for MRI and CT scans, visits to out-patient facilities and physiotherapy. The Emerald
plan furthermore makes full provision for emergency transport to a suitable treatment
5. The Onyx Plan This
is the flagship plan of the Gems Medical Aid
and it offers members extensive access to various health management programs. Qualified nurses are available at all
time to provide advice and guidance regarding the management of conditions such as diabetes, asthma and
cardiovascular conditions. It covers treatment and medication for many chronic conditions and it is even possible
to obtain treatment aimed at mental wellness.
The Gem Medical Aid strives to provide its members with as
many benefits as possible. In order to do so while keeping costs down, members of all the plans have to make use of
an approved network of service providers. The Gems
scheme uses its financial muscle to negotiate favourable rates with these service providers and this is
to the advantage of members. Government employees are certainly fortunate to have such extensive and affordable
medical cover as Gems Medical
Aid available to them.