GEMS: Always a step ahead

It is just over six years since the inception of GEMS thus making it South Africa’s youngest and most dynamic medical scheme, which has grown to become a force to be reckoned with.

Currently, GEMS covers more than 1,5 million beneficiaries, which equates to almost 20% of the South African medical schemes market and three percent of the total population, notes Tintswalo Baloyi, a GEMS Trustee.

Since its establishment, GEMS has broken every record in the South African healthcare funding market. With a strong focus on remaining pro-active and member-centric, GEMS has earned a reputation as an industry pioneer that is always “a step ahead”.

Something for everyone
GEMS has something on offer for everyone with no fewer than five attractive benefit options, namely Sapphire, Beryl, Ruby, Emerald and Onyx providing members with considerable choice and a range of comprehensive healthcare benefit options. The overriding principle behind the GEMS product offering is: “You buy what you need — no more no less.”

Open access and ample choice
GEMS members have access to a network of over 9 000 healthcare providers spanning 35 disciplines. This includes general practioners, optometrists, dentists, physiotherapists, psychologists and a range of other service providers to choose from. Network doctors have access to the rapidly growing GEMS membership; a free listing on the GEMS website and active promotion of the programme by the Scheme. There is also the ‘Friends of GEMS’, a network of 11 757 healthcare providers who have agreed not to charge GEMS members any co-payments for consultations.

These ‘Friends of GEMS’ can be found in all corners of South Africa and are available to GEMS members registered on any of the five Scheme options at the Scheme rate. This gives members the peace of mind that they will never be required to make payments out of their pockets. Healthcare providers are enthusiastic about ‘Friends of GEMS’ and therefore warmly welcome members who make use of the service. As the Scheme is charged directly by the doctors concerned, there are never any uncomfortable discussions about payment or outstanding bills. GEMS members can therefore afford to visit a doctor at any time. This also removes the administration burden from the member who no longer has to submit claims to the Scheme.

Members first, every time
Baloyi indicates that GEMS has adopted a forward-thinking strategy that places members first. In so doing, the Scheme has initiated a number of member-focused initiatives that add to the ‘ease of use’ approach of the Scheme. These include the courier delivery of chronic medication, sending of claims alerts via SMS and ‘Friends of GEMS’- a healthcare service provider registry that enables members to find a healthcare service provider in their area by sending an SMS.

GEMS exists for its members! The needs and perceptions of members are therefore all important to the Scheme and its operations. In order to make it as easy as possible for members to interact with the Scheme a number of channels have been provided. This ranges from feedback on service levels to suggestions regarding new benefits, services or other improvements. In this way GEMS is able to stay in touch with its membership base.

GEMS membership and subsidy
As GEMS is a restricted scheme for Government employees, only those employed within public service can become members of the Scheme. When joining GEMS, public service employees are eligible for a 75% medical scheme subsidy, which is provided by the employer. In certain cases the employer provides a 100% subsidy, up to a limit of R2 570.

A winning recipe
The astonishing growth of GEMS bears testament to the Scheme’s outstanding service provision and member-centric benefit options. Of equal significance is the unrivalled innovation of the Scheme and its ability to design and implement benefits and services that meet and exceed the needs of its members. In this it succeeds admirably with Scheme benefit options being on average 10% to 25% less expensive while benefits are similar, and in certain instances better than those on offer in the market, concludes Baloyi.

Despite the many successes achieved by GEMS the management of the Scheme know all too well that they cannot sit back and rest on their laurels. True to its stated objective GEMS remains totally focused on its members and their individual healthcare needs while providing members with affordable, accessible and quality healthcare services.

The GEMS range of options
Sapphire: An entry level network option that provides out-of-hospital care such as visits to the doctor, dentist, optometry and maternity care at private facilities and in-hospital cover at public facilities

Beryl: An entry level network option that provides both in and out-of-hospital benefits via a network of private facilities

Ruby: A savings account for day-to-day medical expenses as well as a hospital plan

Emerald: A traditional option designed to resemble the medical scheme plan most public service employees were enrolled on prior to the establishment of GEMS

Onyx: A top-of-the-line comprehensive option

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