The GEMS medical scheme is the fastest growing health cover company in South Africa. The name of the scheme (Government Employees Medical Scheme) should be enough to make it clear that it is a closed scheme.
However, there a millions of potential members because the scheme is open to all employees of the government, regardless of the specific level of government.
The national government, provincial governments and even local municipalities are all eligible. The scheme is also open to all pensioners from any level of government.
The inclusiveness of the scheme means that there are millions of potential members. Membership of the scheme is not compulsory but the benefits are excellent and eligible members quickly find that they are not likely to find better cover for the same contribution.
What benefit options are available?
Gems medical aid offers their members five different plans, each catering for distinctly defined target groups.
The Sapphire plan requires members to consult only with medical practitioners that are registered service providers to this specific scheme. Members that opt for other medical professionals will be liable for paying the account themselves. It is up to the member to ensure that the medical professional attending to them is, in fact, a contracted service provider. Visits to specialist must be approved by the scheme in advance.
The Beryl plan is very similar to the Sapphire plan. Members may only make use of approved service providers and specialist services must be approved by the scheme. However, members have better access to chronic medication and day-to-day medical expenses are managed with a savings plan.
The Ruby plan is ideal for those people that suffer from chronic diseases. Various programs are in place to make sure that chronic diseases are managed in and out-of-hospital. The plan also includes a savings plan that is used to cover the cost of out-of-hospital medical expenses. It is necessary to obtain prior approval for admittances to hospital, except during emergencies. Members must make use of approved service providers, although the medical aid has a separate network of providers, other than the network contracted to treat members of the Sapphire and Beryl plans.
The Emerald plan does not differ substantially from the Ruby plan. Members must make use of approved service providers and they have access to specially designed programs aiming at managing chronic diseases and conditions. Conditions such as asthma, cardiovascular disease and even mental wellness are covered with this plan.
The Onyx plan is the flagship of this medical aid. It offers comprehensive benefits that include full cover for in-hospital and out-of-hospital treatments. Members enjoy full access to specialist services, although most of these have to be approved in advance.
Government employees certainly have access to one of the most versatile, financially sound and well-managed medical aid schemes. The scheme itself is convinced that they are the best medical aid, quoting member feedback, auditor reports and their excellent credit rating as proof.
Government employees are free to join other schemes, but if the contribution made by the employer is taken into account, they are not likely to find a better deal with any other company.