Gems Medical Aid
GEMS is a medical aid that is somewhat different to the better known medical aid schemes such as Bonitas medical aid. Gems medical aid has in fact been designed for Government Employees who wish to receive top-class healthcare at affordable rates.
Gem medical aid came about because many employees could not afford healthcare cover or did not feel that they were receiving the best value for money. It was also found that there was little integration with the public health system.
As far as medical aids South Africa go, Gems aims to provide equal access to healthcare benefits for public service employees and lower income earners. The scheme compliments the current public health infrastructure and supports work done by the Department of Health.
Members need to make sure that they adhere to the scheme’s rules and procedures in order to gain the most from membership.
Only certain people may join Gems medical aid, including:
- National Departments
- Provincial Departments
- Provincial Administration
- Certain organizational components
- People who belong to an employer group approved by the scheme
Principal members are issued with a membership card, as are registered adult dependents. The card must be shown to healthcare service providers such as pharmacists, dentists and hospitals upon visitation.
The scheme offers 5 plans:
1. Sapphire – members have access to the Gems network of providers at scheme rates so no additional costs will have to be covered out-of-pocket. A Gems Network logo or sticker will be displayed at all providers who belong to the network for ease of identification.
2. Beryl – members on this plan also have access to the network of providers such as dentists, optometrists and GPs. Visits to specialists need to be based on referrals from a network GP and pathology and radiology tests must be in accordance with the Gems formulary.
3. Ruby – members on this plan will have access to certain care programs in order to help manage chronic diseases and conditions. This means members will receive healthcare support and advice from professionals as well as education regarding certain conditions such as diabetes, asthma and mental wellness.
This plan includes a medical savings account to manage day-to-day medical expenses. Members do not have to use the specified network of professionals but doing so will help with avoiding additional expenditure.
4. Emerald – this plan also offers healthcare support and education and the choice of professionals although consulting professionals outside of the network will result in additional costs. Members who need to go to hospital will need to seek pre-authorisation for visits including out-patient visits and scans as well as in-hospital physiotherapy and ambulance transportation.
5. Onyx – this plan helps with managing chronic medical diseases and other disease management programs. Once again members have the option of using professionals outside of the network at their own expense.
Gems medical aid is ideal for Government Employees seeking top quality medical aid for themselves and their families at reasonable rates.