Gem Medical Aid
Gem medical aid differs to the ordinary schemes such as Discovery medical aid or Bonitas medical aid in that it is aimed at meeting the healthcare needs of government employees. The scheme offers five affordable options for employees that have been created with members’ unique needs in mind.
Gems medical aid was developed with the premise that employees would have equal access to extensive benefits at affordable premiums. The scheme provides access to healthcare for all public service employees as well as providing greater access for lower income earners.
Along with the plans members are able to receive access to medical care at private facilities; disease management programs; HIV/Aids management programs and emergence medical services.
Members on the Sapphire plan are allowed access to a network of healthcare service providers such as pharmacies, dentists, optometrists and GPs. Members of this medical aid will not have to pay excess fees for appointments and treatments within the network and should a specialist be required then a referral will be made by the network GP.
Just like the Sapphire option, members are able to choose from a list of healthcare professionals within the GEMS Network and will only pay scheme rates for appointments and treatments. The plan offers a range of benefits including:
- Out-of-hospital cover
- Chronic medication cover
- HIV/AIDS management
- Oncology management
- Optometry management
- Maternity program and
- Dental management
Like other medical aids, Gem medical aid offers members certain care programmes that help with managing chronic medical diseases and conditions. By opting for such a plan, members will receive adequate support and healthcare from the GEMS Personal Healthcare support team along with qualified professionals. The Ruby option includes a Savings Account and hospital plan.
Members who choose the Emerald option will still need to utilise the Network of professionals in order to avoid paying out-of-pocket expenses although using the network is not obligatory for this plan. Pre-authorisation is required for hospital visits as well as for MRI or CT scans, out-patient visits, in-hospital physiotherapy and ambulance transportation.
The Onyx plan also offers GEMS members specific care programmes that help with managing numerous chronic medical conditions. Support is provided by a team of professionals who will help members to adequately manage chronic diseases.
Nurses will even provide in-depth healthcare education about conditions like diabetes, asthma, cardiovascular management and mental wellness. Further assistance is provided in order to comply with treatments prescribed for conditions.
Members on the Onyx plan do not have to make use of the healthcare network of professionals but if they do they will avoid having to pay any additional expenses.
Pre-authorisation is required for specialised dentistry, out-patient hospital visits, in-hospital treatments such as physiotherapy, radio-isotope studies and MRI or CT scans. Ambulance transportation also requires pre-authorisation from the scheme.
Gem medical aid is a good solution for government employees who want access to top-notch healthcare and assistance at reasonable rates along with full hospital cover and access to a wide range of professionals within the healthcare network.