Gems Medical Scheme

Gems medical scheme, or fully known as South Africa’s Government Employees medical scheme, was created to give government employees affordable medical scheme options and to educate them on health and health-related issues. Gems have replaced all the different medical aid schemes that provided medical cover for government employees.

Gems have a network of approved service providers that are allowed to provide services to all Gems members. As a network plan, all of the monthly contributions are based on the salary the main member earns.

All of the plans at Gems include hospital cover, day-to-day cover that includes dentistry, optometry, GP visits, oncology, a chronic medicine program, maternity program, and an AIDS/HIV management program. You will have to register or apply for some of these programs at GEMS and adhere to the rules of each of them.

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As with all medical aid schemes, the number of GEMS benefits varies according to the selected plans and the premiums paid. We will now take a look at the GEMS options available and their main benefits.

The medical scheme options available at Gems:

• Gems Sapphire: An annual overall in-hospital limit of R156 492 per family. Unlimited GP visits at a network approved GP.

• Gems Beryl: An annual overall in-hospital limit of R782 475 per family. Unlimited GP visits at a network approved GP.

• Gems Ruby: Unlimited hospital cover for prescribed minimum benefit (PMB) conditions and R 12632 per beneficiary for non-PMB hospital stays. Unlimited GP visits at a network approved GP.

• Gems Emerald: Unlimited hospital cover for prescribed minimum benefit (PMB) conditions and R 12632 per beneficiary for non-PMB hospital stays. Day-to-day benefits of R6616 per family per year.

• Gems Onyx: Unlimited hospital cover for prescribed minimum benefit (PMB) conditions and R 12632 per beneficiary for non-PMB hospital stays. Day-to-day benefits of 13913 per family per year.

Who can join Gems medical scheme?

• Employees of a National Department listed in schedule 1 of the Public Service Act.

• Employees of a Provincial Department listed in schedule 2 of the Public Service Act.

• Employees of a Provincial Administration listed in schedule 2 of the Public Service Act.

• Organizational components listed in schedule 3 of the Public Service Act.

• You belong to any employer group listed in the act; there are 14 employer groups listed, they are:

• The National Prosecuting Authority

• The South African Social Security Agency

• Gems employees

• The Armaments Corporation of South Africa

• The South African National Biodiversity Institute.

• The Auditor-General

• The National Youth Commission

• The Parliament of the Republic of South Africa

• The Office of the Public Protector

• The Education Labour Relations Council

• The Council for Medical Schemes

• The Vhembe District Municipality

• The Council on Higher Education

• Any public entity or organ of the state which Public Service Employees that are Gems members are transferred to.

It is clear to see that our government with the help of the Gems medical scheme ensures that their employees receive the best medical aid plans available. They are a good example for all medical aid schemes in South Africa. © Medical Aid Plan

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NOTES:

Your comparative medical scheme 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.