Gems Medical Scheme

Since its inceptions as a closed medical aid the Gems medical scheme has become the fastest growing in South Africa. Properly named the Government Employees Medical Scheme it is closed to employees of the government. However, there are millions of potential members because the scheme does not differentiate between the various levels of government and employees on national, provincial and even local levels all qualify. In addition, the scheme is also open to government pensioners, also regardless of the level where they were employed. Employees are free to join other medical schemes, but few do this because Gems offer such attractive benefits.

What Plans are Offered by Gems Medical Aid Scheme?

The Gems medical scheme offers five distinctive plans, each one catering for very specific needs:

1.   The Sapphire Plan obliges members to make use of pre-approved medical practitioners, treatment facilities and specialists. The onus is upon the member to make sure that the doctor or other medical specialist that he consults with is part of this approved network. If not, the member will be held liable for the cost. In addition, when visits to specialists become necessary, prior approval must be obtained from the scheme.

2.    The Beryl Plan is similar to the Sapphire Plan because members of this plan are also required to make use of contracted service providers and specialists and they also need prior authorization from the scheme before consulting with a specialist. However, this plan includes a medical savings plan that allows members to better manage their day-to-day medical expenses.

3.   The Ruby Plan is ideal for people that suffer from chronic conditions. This plan boasts a variety of programs that help members to manage their in and out-of-hospital medical expenses. Members still need to make use of contracted service providers but the list of these providers is much wider than the one available to members of the Beryl and Sapphire plans. It is also necessary to obtain authorization from the scheme prior to admittance to a hospital. In addition, the Ruby plan includes a medical savings plan that allows members to pay for out-of-hospital medical expenses.

4.  The Emerald Plan is essentially the same as the Ruby plan, but it makes provision for many more chronic conditions, including treatment for mental illnesses, heart disease and asthma. Members must make use of approved service providers and they have to manage their own medical savings plans.

5.  The Onyx Plan is the jewel in the crown of this scheme. Members enjoy unlimited in-hospital cover and comprehensive out-of-hospital cover. All members also have complete and full access to all the health programs managed by the scheme. However, in many cases it is still necessary to obtain prior approval for specialist services.

The Gems medical scheme has certainly grown extremely popular in a very short time span. Of all the medical schemes in South Africa they boast the highest percentage of client satisfaction. Most government employees have opted for this scheme and it is certainly unlikely that they will find a better plan at the same price.

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.