GEMS Medical Aid Information
In the world of medical aid, GEMS is a less well known scheme than other industry ones such as Bonits medical aid. It is a scheme designed specifically for Government employees who want the best healthcare at competitive prices.
GEMS Medical Aid came about as a large number of employees were not in a position to afford healthcare on the general market or felt they were not getting the best possible care for the money they were spending. GEMS identified that there was also an opportunity for integration within the healthcare system to benefit members and solve these concerns.
GEMS Healthcare Benefits
In South Africa, GEMS looks to secure equal access to great healthcare for public sector workers andthose on lower wages. It works by complementing the existing public health facilities offered by the Department of Health.
The best way of getting the most from membership of these schemes is by ensuring that members always work within the rules and procedures of the scheme.
Membership of the scheme is restricted to certain groups of people including:
- National Government workers
- Provincial Government workers
- Provincial administration staff
- People employed by organisations approved by the scheme
Members and adult dependents are issued with a GEMS medical card. The card needs to be displayed every time a visit to a healthcare service provider such as a hospital, doctor, or dentist is made.
GEMS Five Plans
There are five different plans in the GEMS scheme. Each plan offers members a different set of benefits for them to choose between so they end up with care that meets their needs. Plans include:
Sapphire – members are given access to GEMS approved providers at scheme rates which means they do not need to worry about meeting out-of–pocket expenses. Members should look for healthcare facilities displaying the GEMS logo on a sticker.
Beryl – access to a range of additional providers such as optometrists and GPs is provided to members of this plan. Members need to ensure their visit is made as part of a referral by another GEMS healthcare provider. Any radiology tests should also follow GMS scheme procedures.
Ruby – members benefit from accessing a range of care providers who specialise in treating chronic disease and conditions. They will also benefit from access to a range of education programmes regarding important conditions such as mental health, asthma, and diabetes.
Emerald – enjoy a choice of professionals alongside the healthcare support services if you are an emerald member. Members need to seek preauthorisation before visiting a consultant. Non-scheme consultants can be used although some additional charges may need to be met by the member.
Onyx – members get special help tailored to meet their needs when managing chronic medical diseases and other disease management issues. It is possible to use professionals not part of the scheme where members are prepared to cover additional charges themselves.
GEMS medical plans are perfect for Government employees who wish to secure top quality treatment for themselves and their family members.