Gems Medical Scheme
Since its inceptions as a closed medical aid
the Gems medical scheme has become the fastest growing in South Africa. Properly named the Government Employees
Medical Scheme it is closed to employees of the government. However, there are millions of potential members because the scheme does not
differentiate between the various levels of government and employees on national, provincial and even local
levels all qualify. In addition, the scheme is also open to government pensioners, also regardless of the
level where they were employed. Employees are free to join other medical schemes, but few do this because Gems
offer such attractive benefits.
What Plans are Offered
by Gems Medical Aid Scheme?
The Gems medical scheme offers five
distinctive plans, each one catering for very specific needs:
1. The Sapphire Plan obliges
members to make use of pre-approved medical practitioners, treatment facilities and specialists. The onus is upon
the member to make sure that the doctor or other medical specialist that he consults with is part of this approved
network. If not, the member will be held liable for the cost. In addition, when visits to specialists become
necessary, prior approval must be obtained from the scheme.
2. The Beryl Plan is
similar to the Sapphire Plan because members of this plan are also required to make use of contracted service
providers and specialists and they also need prior authorization from the scheme before consulting with a
specialist. However, this plan includes a medical savings plan that allows members to better manage their
day-to-day medical expenses.
3. The Ruby Plan is ideal for
people that suffer from chronic conditions. This plan boasts a variety of programs that help members to manage
their in and out-of-hospital medical expenses. Members still need to make use of contracted service providers but
the list of these providers is much wider than the one available to members of the Beryl and Sapphire plans. It is
also necessary to obtain authorization from the scheme prior to admittance to a hospital. In addition, the Ruby
plan includes a medical savings plan that allows members to pay for out-of-hospital medical
4. The Emerald Plan is essential the
same as the Ruby plan, but it makes provision for many more chronic conditions, including treatment for mental
illnesses, heart disease and asthma. Members must make use of approved service providers and they have to manage
their own medical savings plans.
5. The Onyx Plan is the jewel in the
crown of this scheme. Members enjoy unlimited in-hospital cover and comprehensive out-of-hospital cover. All
members also have complete and full access to all the health programs managed by the scheme. However, in many cases
it is still necessary to obtain prior approval for specialist services.
The Gems medical scheme has certainlygrown extremely popular
in a very short time span. Of all the medical schemes in South Africathey boast the highest percentage of client
satisfaction. Most government employees have opted for this scheme and it is certainly unlikely that they will find
a better plan at the same price.