Gem Medical Aid for Government Employees
Gem medical aid is a unique scheme that was designed to provide services to government employees throughout South Africa. It is different from other schemes, such as Cape Medical Aid, Selfmed or Medihelp. Its establishment was of course in response to the high demand for medical aid in South Africa.
In acknowledging the large pool of its potential members, the schemes offers five optional products specially designed to accommodate the uniqueness of its clientele.
The main Gem products or plans are:
The objective of Gem Medical Aid, among others, is to provide government employees with medical aid that would benefit them extensively but at a very affordable price. With this scheme, public services employees, who are understandably in the lower-income bracket, can have access to affordable medical aid as well as enjoy a range of disease management programmes they would otherwise not manage to pay for.
The scheme also makes medical care offered by private facilities affordable to its government employee membership. Added to the list of such benefits are emergency medical services as well as HIV and AIDS management programmes.
Services Requiring Pre-authorisation
Whereas Gem Medical Aid aims at making medical cover affordable to its members, a number of services have been exempted and need pre-authorisation before a member can access them.
These include the visit to the dentist, physiotherapy, MRI and CT scans, radio-isotope studies and out-patient hospital visits. The members also need pre-authorisation should they need the services of an ambulance.
Gem Medical Aid Plans
Gem Medical Aid Sapphire Plan
By subscribing to the Sapphire plan, members are able to see the general practitioner, the dentist and optometrists. This plan also allows the member to obtain services of a pharmacy. However, all these services and facilities that the members can have access to are in a defined network. Therefore, members are restricted to a select network of providers and may not seek services outside of that network. In case of the need for specialist treatment, the scheme has the prerogative to assign a general practitioner to make a referral for such a case.
Gem Medical Aid Beryl Plan
The Beryl plan is more or less similar to the Sapphire plan in that members are provided with pool, or a network of healthcare services within the Gems network. Apart from paying for appointments and treatments, members also enjoy the benefits of a wide range of services that include chronic medication cover, HIV and AIDS management and out-of-hospital cover. There is also a provision covering oncology, dental and optometry management as well as a robust maternity programme.
Gem Medical Aid Ruby Plan
This plan is designed especially for those members that need help in the management of chronic conditions and diseases. In line with its objective, this plan goes with a hospital plan to adequately cover a member in need of such service. It also has a savings account!
Gem Medical Aid Emerald Plan
In terms of Gem medical aid comparison, the Emerald plan does not differ that much from the other plans when it comes to the restriction of the professionals and services that a member can access. It outlines that this can only be done within the network provided for. Using professionals and services outside of the prescribed network attracts out-of-pocket payment from a member who does that. The Emerald plan also requires prior authorisation for such services as physiotherapy and ambulance transportation, as well as MRI and CT scans.
Gem Medical Aid Onyx Plan
This plan outlines specific care programmes, such as the management of numerous chronic medical conditions, which members can benefit from. Specialist treatment and health education is provided for such as conditions as diabetes, mental wellness, asthma and cardiovascular management. Onyx members are exempted from the restriction to the healthcare providers’ networks prescribed by the scheme.
Of all the medical aid schemes, Gem medical aid stands out as the best tailored for public service employees. Its rates as reasonably affordable for the services provided.© Medical Aid Plan
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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.