The Gems Medical Aid scheme is a closed scheme and can
only be enjoyed by government employees. In fact, the acronym Gems stands for Government Employees Medical Scheme.
In the past government employees at the many different levels of government were
members of a variety of schemes and Gems was created to consolidate the needs of the state. It provides
quality care and the scheme has quickly established itself as one of the medical schemes to be reckoned with.
It offers a host of services, including hospital plans and more comprehensive cover.
The Main Benefits Offered By
One of the biggest advantages offered by Gems is the
fact that they offer equal care to all income groups within the government system. It also provides support to the
public health system and the South African Department of Health. Currently, the following people qualify for
·Employees at national departments
·Those working for provincial departments
·Provincial administration employees
·Employees who work for employers that are approved by the scheme
·Some of the employees from organizational components that have close connections with government
Principal members and main adult beneficiaries of
Gems Medical Aid are issued
with membership cards that must be tendered every time health care is sought. The membership card contains detail
regarding the member and the specific hospital plan or comprehensive plan he or she is a member of. There
are five main plans:
Sapphire plan offer members treatment at anyone in the approved network of service providers. These providers have
agreed to provide their services at approved medical aid rates. Members therefore never have to pay additional
expenses, as long as they use the members of the approved network. Most approved service providers will display a
notice to this effect.
2.Members of the Beryl Plan enjoy all the
benefits listed above but they also have access to a network of approved specialists, dentist and even
optometrists. It is required to obtain a reference from a general practitioner before access to specialist
treatment can be obtained.
3.Members of the Ruby Plan do not have to use
only service providers that are part of the approved network. However, if the chosen specialist charges above the
approved medical rate the additional cost will be for the pocket of the member.
Emerald Plan also allow members to choose their own medical professionals but they, too, must be willing to carry
the cost of such consultations and treatments if it is above the approved medical rate. Members are fully covered
for in-hospital expenses but they need prior approval from the fund before being admitted. This does not apply to
emergencies, of course. The Emerald Plan also covers emergency transport and a host of preventive treatment
Onyx Plan is ideal for those employees who wish to enjoy all the benefits of the plans discussed above but that
also need comprehensive disease management programmes.