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Choosing a Medical Aid in South Africa


 

  

  

Gem Medical Aid, the Healthy Choice for SA Government Employees

Gem Medical Aid is a closed medical aid scheme aimed at medical treatment and healthcare for employees of the government.

Gem medical aid,The idea behind Gems is that all employees will have the same access to benefits, catering for employees with lower income as well.

Each member will have the following benefits, irrespective of which plan you belong to:

· Access to private facilities for a broad spectrum of medical care. You can choose which facility.

· Claims are paid promptly every 14 days.

· Communications with members on a regular basis.

· Customer service is efficient and done in a friendly manner.

· DMP for managing costs and treatments for chronic diseases.

· Emergency medical treatment is covered in most parts of South Africa.

· HIV/Aids DMP, or Disease Management Program gives health care on a confidential basis

· Medical information is kept private and is seen as confidential information.

· Medical services in an emergency.

· Monthly payments are affordable and calculated according to your salary.

 There are five different Gems medical aid plans government employees can choose from, with different gemstone names.

 Sapphire

Sapphire medical scheme members can choose from the network general practitioners, dentists, optometrists and pharmacists for their medical care visits. These visits are unlimited and you will not need to pay any additional fees. Should you need to visit a specialist, the general practitioner in the network, will refer you to the specialist. A wide variety of doctors belong to this approved network. 

 Beryl

Beryl medical plan also has the option of choosing the doctor, dentists, optometrist or pharmacist from the approved network. If you go to one of the network professionals, the approved medical aid rate for medical treatment and visits are covered. In addition to the general cover for all members are the following:

· Day-to-day care

· Dental management

· Cover for chronic medications

· Maternity program

· Oncology management

· Optometry management

 Ruby

Ruby is ideal for the person who has a chronic medical illness. GEMS Personal Healthcare support group consists of professionals that are qualified to assist you in managing your chronic illness. Included in the Ruby plan are a hospital plan and a Savings Account.

 Emerald

Emerald plan members also use the approved network of medical professionals, thereby avoiding paying any additional costs. However, you are not obligated to visit medical professionals from the approved network.

Authorization prior to admittance, a visit or treatment is necessary for the following treatments and procedures:

· Ambulance transportation

· CT scans

· MRI scans

· Hospital visits

· Out-patient visits

· Physiotherapy

 Onyx

Onyx plan members are not obligated to visit the medical professionals in the network group. However, should they visit professionals outside of the network; they can be held responsible for additional costs. Onyx plan has specific management programs that assists member who have chronic medical diseases. The team consists of medical professionals who can assist the patient in handling and managing their chronic medical disease. There are nursing staff that will help with healthcare and education on disease such as asthma, cardiovascular disease, diabetes and mental illnesses. Assistance is also given according to the prescribed treatment for the disease.

Gem medical aid is the perfect scheme for government employees requiring good medical and health care at affordable rates. © Medical Aid Plan.