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Choosing a Medical Aid in South Africa


 

  

  

Gems Medical Aid

Gems Medical Aid is a medical scheme for employees of the South African government and that is what the initials GEMS stands for, namely Government Employees Medical Scheme.Gems Medical Aid

The scheme have two purposes, the one is to create an affordable medical aid scheme for government employees. The other purpose is to educate employees on healthcare and issues related to health. Gems is in the place of all other medical aids and schemes that previously provided medical and health cover for employees of the government.

Gems hasapproved certain service providers. These service providers provide the health and medical services to all members of the Gems medical aid.

All the medical aid schemes of Gem include the following:

· Day-to-day cover including general practitioner visits, dentist, optometrist,

· Hospital cover

· Maternity program

· Program for HIV/Aids management

· Chronic medicine cover

Which government employees are eligible to apply for the Gems medical scheme?

· Organizational components listed in Public Service Act, Schedule 3

· National Department employees listed in the Public Service Act, Schedule 1

· National Prosecuting Authority

· Provincial Administration employees listed in Public Service Act, Schedule 2

· Provincial Department employees listed in Public Service Act, Schedule 2  

 

If you belong to any of the 14 employer groups listed in the Act, you are eligible to be a member of the Gems scheme:

· Armaments Corporation of South Africa

· Auditor-General

· Council on Higher Education

· Council for Medical Schemes

· Education Labour Relations Council

· Gems employees

· National Prosecuting Authority

· National Youth Commission

· Office of the Public Protector

· Parliament of the Republic of South Africa

· South African National Biodiversity institute.

· South African Social Security Agency

· Vhembe District Municipality

· If Gems members who are Public Service Employees are transferred to a public entity

The benefits of the different plans are according to the payment the member makes.

There are 5 medical aid plans:

· Sapphire is an annual hospital plan that covers hospital expenses of your family to the limit of R156 492 per year. Included in the Sapphire, are unlimited visits to your general practitioner, provided your doctor is one of the approved network doctors.

· Beryl has a hospital treatment cover of R782 475 per annum, for your family. Unlimited visits to your general practitioner are covered if he is part of the network doctors.

· Ruby has hospital cover that is unlimited for conditions that qualify as PMB, or prescribed minimum benefit. For non-PMB hospital admittance, the amount per recipient is limited to R 12632. Visits to general practitioners who are approved are unlimited.

· Emerald has unlimited cover for hospital for PMB conditions. Non-PMB hospital admittance is limited to R 12632 per recipient. The yearly cover for day-to-day medical care per family is R6616.

· Onyx has unlimited cover for hospital admittance for PMB conditions, and a yearly cover of R 12,632 per recipientfor non- PMB hospital admittance. Day-to-day cover for your family per year is R 13,913.

Gems medical aid, as the government medical aid in South Africa, would like to be seen as the example of how medical aids should care for their members. © Medical Aid Plan