Gem Medical Aid, the Healthy Choice for SA Government Employees
Gem Medical Aid is a closed medical aid scheme aimed at medical treatment and healthcare for employees of the government.
The idea behind Gem is that all employees will have the same access to benefits, catering for employees with lower income as well.
Each Gem member will have the following benefits, irrespective of which plan you belong to:
Access to private facilities for a broad spectrum of medical care. You can choose which facility.
Gem claims are paid promptly every 14 days.
Communications with members on a regular basis.
Customer service is efficient and done in a friendly manner.
DMP for managing costs and treatments for chronic diseases.
Emergency medical treatment is covered in most parts of South Africa.
HIV/Aids DMP, or Disease Management Program gives health care on a confidential basis
Medical information is kept private and is seen as confidential information.
Medical services in an emergency.
Monthly payments are affordable and calculated according to your salary.
There are five different Gem medical aid plans government employees can choose from, with different gemstone names.
Gem Medical Aid – Sapphire
Sapphire medical scheme members can choose from the network general practitioners, dentists, optometrists and pharmacists for their medical care visits. These visits are unlimited and you will not need to pay any additional fees. Should you need to visit a specialist, the general practitioner in the network, will refer you to the specialist. A wide variety of doctors belong to this approved network.
Gem Medical Aid – Beryl
Beryl medical plan also has the option of choosing the doctor, dentists, optometrist or pharmacist from the approved network. If you go to one of the network professionals, the approved medical aid rate for medical treatment and visits are covered. In addition to the general cover for all members are the following:
Day-to-day care
Dental management
Cover for chronic medications
Maternity program
Oncology management
Optometry management
Gem Medical Aid – Ruby
Ruby is ideal for the person who has a chronic medical illness. GEMS Personal Healthcare support group consists of professionals that are qualified to assist you in managing your chronic illness. Included in the Ruby plan are a hospital plan and a Savings Account.
Gem Medical Aid – Emerald
Emerald plan members also use the approved network of medical professionals, thereby avoiding paying any additional costs. However, you are not obligated to visit medical professionals from the approved network.
Authorization prior to admittance, a visit or treatment is necessary for the following treatments and procedures:
Ambulance transportation
CT scans
MRI scans
Hospital visits
Out-patient visits
Physiotherapy
Gem Medical Aid – Onyx
Onyx plan members are not obligated to visit the medical professionals in the network group. However, should they visit professionals outside of the network; they can be held responsible for additional costs. Onyx plan has specific management programs that assist members who have chronic medical diseases. The team consists of medical professionals who can assist the patient in handling and managing their chronic medical disease. There are nursing staff that will help with healthcare and education on disease such as asthma, cardiovascular disease, diabetes and mental illnesses. Assistance is also given according to the prescribed treatment for the disease.
Gem medical aid is the perfect scheme for government employees requiring good medical and health care at affordable rates. © Medical Aid Plan.
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NOTES:
Your medical aid 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.