GEMS Medical Aid: detailed overview 2019

GEMS Medical Aid: detailed overview 2019

GEMS Medical Aid is a government health plan for its workers. The government employee medical scheme is meant to be affordable and one that most, if not all government workers can opt for as opposed to private covers.

GEMS Medical Aid

Image: facebook.com, @gems
Source: UGC

The need for a reliable medical cover cannot be overemphasized. With health emergencies occurring unexpectedly, these unplanned expenses can take a toll on the family since they cannot be pushed forward. While this is a reality that many South Africans are faced with, there is a certain fear attached to insurance covers. Questions such as who may join GEMS are therefore not uncommon. Everyone needs to know if this is a plan that can work for them and help them out when the situation is truly dire.

So, who can join the scheme?

Well, anyone can join as long as they are permitted by the terms and conditions. Usually, the following are the most popular members of GEMS. You must be an employee of the following departments:

  • Organisational components listed in Schedule 3 of the Public Service Act
  • A National Department listed in Schedule 1 of the Public Service Act
  • A Provincial Administration listed in Schedule 2 of the Public Service Act
  • A Provincial Department listed in Schedule 2 of the Public Service Act
  • Any employer group approved by the Scheme (a list of these employers is available in Annexure A of the Scheme Rules).

Just as there are members that are allowed to join the scheme, the following are not permitted to be covered under the program:

  • The National Intelligence Agency (NIA)
  • The South African National Defence Force (SANDF)
  • Uniformed members of the South African Police Service (SAPS)
  • The South African Secret Service (SASS)
  • Any department where the conditions of service do not allow you to join GEMS.

How to join GEMS?

GEMS Medical Aid

Image: facebook.com, @gems
Source: UGC

As you look to explore the different GEMS Medical Aid options 2019 has to offer; you need to get the basics right. It is necessary to know how to join. You will have to make an online application first. The online process begins by answering certain questions that determine whether or not you are qualified for membership. You will need to supply your employment details and answer a few questions for you to be ascertained. You may have to fill in more GEMS Medical Aid forms to complete your application.

Expected benefits

Even as you get the GEMS Medical Aid contact details for further clarifications, it is important for you to know and understand the different packages and benefits available on offer. You need to note that all GEMS Medical Aid claims can be made only after you have complied with certain requirements. It is advisable therefore to know what is expected of you from the start. The benefits will be outlined based on the different plans available.

1. Sapphire in-hospital benefits

The following areas are covered with certain limits depending on Prescribed minimum benefits (PMBs). Merits on this plan as of 2019 include coverage on the following areas:

  • Annual hospital benefit for both public and private hospitals, registered unattached theatres, day clinics and psychiatric facilities.
  • Alcohol and drug dependencies
  • Allied health services which include social workers, dietitians, physiotherapists, and orthopedists among others
  • Alternatives to hospitalization (sub-acute hospitals and private nursing)
  • Blood transfusion
  • Dental services (conservative, restorative and specialized)
  • Emergency services (casualty department)
  • GP and Specialist services
  • Mental health
  • Oncology (chemo and radiotherapy)
  • Organ and tissue transplants
  • Pathology and Medical Technology
  • Medical and surgical appliances and prostheses
  • Radiology (advanced)
  • Radiology (basic)
  • Renal dialysis
  • Surgical procedures (including maxillofacial surgery)

2. Sapphire out-of-hospital benefits

The gains here include:

  • Allied health services
  • Audiology, occupational therapy and speech therapy
  • Chronic Back and Neck Rehabilitation Programme
  • Circumcision
  • Contraceptives (oral, insertables, injectables and dermal
  • Dental services (conservative, dentistry including acute medicine)
  • Emergency assistance (road and air)
  • General Practitioner (GP) and Specialist services
  • HIV infection, AIDS and related illness
  • Infertility
  • Maternity (ante- and post-natal care)
  • Medical and surgical appliances and prostheses
  • Mental health (Consultations, assessments, treatment and/or counselling by GP, Psychiatrist, Psychologist)
  • Optical services (eye examinations, frames, lenses, permanent or disposable contact lenses and acute medicine)
  • Pathology
  • Physiotherapy
  • Prescribed medicine and injection material
  • Preventative care services
  • Screening services
  • Radiology (advanced)
  • Radiology (basic)
  • Renal dialysis

The types of out-of-hospital and in-hospital benefits are the same across all the plans offered. The difference comes in the details of what is offered on each package. This means that users must be keen when settling for a plan that works for them. In addition to that, you need to read the exceptions and subjection on each of the benefits as most of the gains are subjective. The other plans you should consider apart from the two mentioned above are:

READ ALSO: The 10 changes to medical schemes South Africans need to know about

3. Beryl in-hospital benefits

GEMS Medical Aid

Image: facebook.com, @gems
Source: UGC

This plan offers gains when you are hospitalized

4. Beryl out-of-hospital benefits

The plan offers merits when seeking help out of hospital admission.

5. Ruby in-hospital benefits

Offers an alternative for when you are admitted in a hospital.

6. Ruby out-of-hospital benefits

It gives patients an option for an outpatient health cover package.

7. Emerald Value in-hospital benefits

Also offers an alternative for admission in hospital.

8. Emerald Value out-of-hospital benefits

Alternate solution for outpatient subscribers.

9. Emerald in-hospital benefits

Evaluate the package and monthly contributions of the in-hospital cover before making a decision.

10. Emerald out-of-hospital benefits

You can opt for the outpatient hospital deal for when you need services from a hospital without admission.

11. Onyx in-hospital benefits

In the event that you are hospitalized, this plan can be an alternative.

12. Onyx out-of-hospital benefits

This out of hospital plan will work for anyone who can afford it.

With so many options available for different users, civil servants need to evaluate themselves before picking a plan that works for them. The best way to get details on contributions and any clarifications on gains would be to contact GEMS Medical Aid directly. Whatever you choose, you can be assured that no medical emergencies will put unnecessary pressure on your finances.

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Source: Briefly.co.za

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