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Choosing a Medical Aid in South Africa


 

  

  

About Gems Medical Aid 

Gems Medical Aid is one of a number of closed medical aid schemes in South Africa. It was launched on 1st January 2005, borne out of the need to serve a particular group of members – public service employees. The establishment of this scheme stems from a Cabinet approved framework back in 2002 that came up with the idea for a closed scheme to serve public service employees at all levels of government.

gems medical aidBy its nature, Government Employees Medical Scheme (or GEMS) is one of the fastest growing medical schemes in the country as it is open to a pool of millions of potential members in public service.

Apart from serving government employees at all levels and in all government structures, GEMS also has its doors open wide to pensioners irrespective of the level of government they hail from.

However, GEMS membership must not be misunderstood. Membership to GEMS by government employees is not automatic or compulsory. All workers in public service are at liberty to seek alternative medical scheme services. Be that as it may, GEMS medical aid is a competitive one on the market and members are exposed to equally good service and benefits that they, actually, might not get at the same rates as they would with GEMS.

 What is medical aid?

Medical aid is a facility that takes care of a member’s medical or health care expenses they would otherwise not afford to pay from their pocket at one go. Medical schemes design plans that they offer their potential members to choose from. This is done with a needs assessment and affordability.

GEMS comes up as the ideal option for the huge majority of government employees. It is the natural option, or alternative.

Like other schemes, GEMS does have plans that provide cover to clearly defined groups.

 The Sapphire plan

This plan covers healthcare provided by practitioners or healthcare service providers that are registered with the scheme. Seeking services from non-scheme registered providers entails that the member would pay the account from their own pocket. To add on to that, members are expected to verify and confirm that the practitioner attending to them is accredited to the scheme. The scheme reserves the right to approve any specialist visits.

 The Beryl plan

Apart from having access to services for the treatment or management of chronic illnesses or condition, the Beryl plan is quite similar to the Sapphire plan. Day-to-day medical expenses are taken care of on an aptly set-up savings plan.

 The Ruby plan

This is the plan that is best designed for members faced with chronic conditions or illness. Although this plan has a hospital plan as well as a savings one, admission to hospital requires prior approval from the scheme. As with the Sapphire and Beryl plans, members can only make use of accredited healthcare providers and practitioners. Otherwise, members must foot the bills themselves.

 The Emerald plan

This plan, like the Ruby plan, also demands use of only scheme approved healthcare providers. The plan also provides for programmes specially designed to address chronic conditions and illnesses, including cardiovascular disease,asthma and even mental wellness.

 The Onyx plan

Equipped with one of the best hospital plans, the Onyx plan is a comprehensive cover that takes care of a member’s full cover for in-and-out-of-hospital treatments. Despite being restricted to prior approval, full access to specialist services is available to all members.

Gems Medical Aid is a scheme that offers government employees an affordable option to quality medical aid.© Medical Aid Plan.

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