Gem Medical Aid
The Gem Medical Aid caters exclusively for the medical cover needs of government employees in South Africa. The name Gem stands for "government employees medical".
The scheme was brought into life in order to provide quality medical cover to all employees at all levels of government; national, provisional and local. It furthermore aims to provide equal benefits to lower income employees.
The scheme is therefore closed to the general public but state pensioners are able to apply for membership, once again regardless of the level of government where they were employed prior to retirement.
What Plans Does the Gems Medical Scheme Offer?
There are five distinct plans that are designed to meet the needs of very specific target groups:
1. The Sapphire Plan Members of this plan are required to make use of a network of service providers that are under contract with the scheme. This includes general practitioners, dentists, pharmacies and optometrists. If members keep to this network, they are not required to pay a portion of the cost of treatment but if they stray from the list they can be liable for the cost. Specialist services may only be sought after prior approval by the scheme.
2. The Beryl Plan As with the Sapphire plan, members must make use of medical professionals that are part of the Gems network of approved service providers. This plan, however, also makes provision for out-of-hospital cover, medication for chronic conditions, dental benefits, oncology treatment, dental cover and it even offers full maternity benefits.
3. The Ruby Plan This plan includes a medical savings plan that allows members to manage the cost of day-to-day medical care. Members also have full access to the Gems Personal Healthcare Support team. The plan includes full in-hospital cover and medication for chronic conditions are included. However, members must obtain approval from the scheme prior to hospitalization or before specialist are consulted.
4. The Emerald Plan This plan resembles the Ruby plan because members must still make use of the Gems network of approved service providers and they have to obtain authorization before in-hospital benefits can be claimed. The difference is that this plan also offers cover for MRI and CT scans, visits to out-patient facilities and physiotherapy. The Emerald plan furthermore makes full provision for emergency transport to a suitable treatment facility.
5. The Onyx Plan This is the flagship plan of the Gems Medical Aid and it offers members extensive access to various health management programs. Qualified nurses are available at all time to provide advice and guidance regarding the management of conditions such as diabetes, asthma and cardiovascular conditions. It covers treatment and medication for many chronic conditions and it is even possible to obtain treatment aimed at mental wellness.
The Gem Medical Aid strives to provide its members with as many benefits as possible. In order to do so while keeping costs down, members of all the plans have to make use of an approved network of service providers. The Gems scheme uses its financial muscle to negotiate favourable rates with these service providers and this is to the advantage of members. Government employees are certainly fortunate to have such extensive and affordable medical cover as Gems Medical Aid available to them.
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Your medical aid quote will include options to suit your pocket. Please ensure that the cover you select is exactly what you need and that you understand exactly what insurance you are buying. Do not hesitate to ask questions about the medical aid or hospital cover you choose.