Medical Aid for Government
medical aid is a unique scheme that was designed to provide
services to government employees throughout South Africa. It is different from other schemes, such as Cape Medical
Aid, Selfmed or Medihelp. Its establishment was of course in response to the high demand for medical aid in South
In acknowledging the large pool of its potential
members, the schemes offers five optional products specially designed to accommodate the uniqueness of its
The main products or plans
of Gem Medical Aid, among others, is to provide government employees with medical aid that would benefit them
extensively but at a very affordable price. With this scheme, public services employees, who are understandably in
the lower-income bracket, can have access to affordable medical aid as well as enjoy a range of disease management
programmes they would otherwise not manage to pay for.
The scheme also makes
medical care offered by private facilities
affordable to its government employee membership. Added to the
list of such benefits are emergency medical services as well as HIV and AIDS management
Services Requiring Pre-authorisation
Whereas Gem Medical Aid aims at making medical
cover affordable to its members, a number of services have been exempted and need pre-authorisation before a
member can access them.
These include the visit to
the dentist, physiotherapy, MRI and CT scans, radio-isotope studies and out-patient hospital visits. The members
also need pre-authorisation should they need the services of an ambulance.
Gem Medical Aid Plans
By subscribing to the
Sapphire plan, members are able to see the general practitioner, the dentist and optometrists. This plan also
allows the member to obtain services of a pharmacy. However, all these services and facilities that the members can
have access to are in a defined network. Therefore, members are restricted to a select network of providers and may
not seek services outside of that network. In case of the need for specialist treatment, the scheme has the
prerogative to assign a general practitioner to make a referral for such a case.
The Beryl plan is more or
less similar to the Sapphire plan in that members are provided with pool, or a network of healthcare services
within the Gems network. Apart
from paying for appointments and treatments, members also enjoy the benefits of a wide range of services
that include chronic medication cover, HIV and AIDS management and
out-of-hospital cover. There is also a provision covering oncology, dental and optometry management as well as a
robust maternity programme.
This plan is designed
especially for those members that need help in the management of chronic conditions and diseases. In line with its
objective, this plan goes with a hospital plan to adequately cover a member in need of such service. It also has a
In terms of medical aid
comparison, the Emerald plan does not differ that much from the other plans when it comes to the restriction of the
professionals and services that a member can access. It outlines that this can only be done within the network
provided for. Using professionals and services outside of the prescribed network attracts out-of-pocket payment
from a member who does that. The Emerald plan also requires prior authorisation for such services as physiotherapy
and ambulance transportation, as well as MRI and CT scans.
This plan outlines specific
care programmes, such as the management of numerous chronic medical conditions, which members can benefit from.
Specialist treatment and health education is provided for such as conditions as diabetes, mental wellness, asthma
and cardiovascular management. Onyx members are exempted from the restriction to the healthcare providers’ networks
prescribed by the scheme.
Of all the medical
aid schemes, Gem medical aid stands out as the
best tailored for public service employees. Its rates as reasonably affordable
for the services provided.© Medical Aid
To get your medical aid plan quote by