GEMS medical aid scheme: Get a detailed overview for 2024

The Government Employees Medical Scheme offers affordable medical coverage to South African civil servants and their nominated beneficiaries. The program has over 800,000 principal members and about 2 million beneficiaries. Learn about the different policies the GEMS medical aid scheme offers, their features, and current prices below.

The GEMS medical aid scheme has six packages, all priced differently to accommodate public service employees earning different income levels. Gain insights into the current GEMS medical aid options and prices in 2024 below.

GEMS medical aid scheme options and prices

Government health insurance plans are mostly cheaper or have more benefits/features than most health plans offered by private insurance companies. GEMS medical aid scheme options discussed in this article are:

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Learn more about GEMS options and prices below. The information can help you choose the most suitable health plan for yourself and your loved ones.

1. Tanzanite One - From R1 363 monthly

Tanzanite One was previously known as Sapphire. It is the most affordable of all GEMS medical aid options. The entry-level package is tailored for employees in income levels 1-5. The Tanzanite One prices are:

Tanzanite One features

The features of Tanzanite One include:

• Comprehensive cover for both in-hospital and out-of-hospital benefits.
• Full access to a network of private hospitals
• Unlimited GP and specialist consultations (must adhere to care coordination rules)
• Comprehensive In-hospital benefits (subject to state and GEMS network facilities)
• Access to over-the-counter (OTC) medication
• All salary level 1-5 members may enjoy a subsidy of up to 100% from their employer. You get much more by paying less!

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2. Beryl - From R1 538 monthly

The GEMS Beryl health insurance plan is a slightly pricier entry-level package. It is designed for workers with low to medium healthcare needs. The Beryl prices are:

Beryl features

Some of the Beryl GEMS plan features are:

• Access to Beryl GEMS Network providers and medicine on the applicable GEMS formulary list.
• Access to public facilities.
• Comprehensive in-hospital benefits for healthcare services rendered in and by public and private hospitals to a specified limit per family per annum.
• Comprehensive out-of-hospital benefits for healthcare services typically rendered by healthcare providers on the GEMS network, subject to specialist referral and network GP rules.
• Three additional non-PMB chronic conditions

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3. Emerald Value - From R2 975 monthly

Emerald Value is an efficiency-discounted option of the Emerald package. It is tailored for members with average to above-average healthcare needs. The Emerald Value's prices are:

Emerald Value features

Here is a look at its features.

• 41 additional non-PMB chronic conditions.
• Access to Emerald GEMS Network providers and medicine on the applicable GEMS formulary list, accessible on the GEMS website.
• Access to public facilities.
• Comprehensive in-hospital benefits for healthcare services rendered in and by public and private hospitals to a specified limit per family per annum.
• Comprehensive out-of-hospital benefits for healthcare services typically rendered by healthcare providers on the GEMS network, subject to specialist referral and network GP rules.
• Family Practitioner Network Extender benefits once the PMSA and block benefits are exhausted.
• Members of Emerald who switch to the Emerald Value option will experience greater savings on their monthly contribution while enjoying the same benefits they would on Emerald. However, one must nominate a Network GP to qualify.

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4. Ruby - From R3 180 monthly

Ruby is a mid-level benefit option tailored for public service employees with limited to average healthcare needs. This medical aid covers suits those who wish to enjoy a personal medical savings account. Ruby's prices are:

Ruby features

Here is a look at the package's main features.

• Comprehensive out-of-hospital benefits for healthcare services typically rendered by healthcare providers on the GEMS network, subject to specialist referral and network GP rules.
• Comprehensive out-of-hospital benefits for healthcare services.
• Personal Medical Savings Account (PMSA) and Block benefits from which some healthcare services are funded.
• Family Practitioner Network Extender benefits once the PMSA and block benefits are exhausted.
• Eight additional non-PMB chronic conditions coverage
• Access to public facilities

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5. Emerald - From R3 554 monthly

Emerald is a high-level option tailored for members with average to above-average healthcare needs. Prices for the Emerald GEMS option are:

Emerald features

Here are the package's main features.

• Comprehensive in-hospital benefits for healthcare services.
• Comprehensive out-of-hospital benefits for healthcare services.
• Once the day-to-day Block benefit is exhausted, a Primary Care extender benefit and a Family Practitioner Network Extender Benefit will be provided.
• 41 additional non-PMB chronic conditions.
• Access to public facilities.

6. Onyx - From R6 162 monthly

Onyx is a top-level benefit option tailored for members with above-average to extensive healthcare needs. Prices for the Onyx GEMS option are:

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Onyx features

Here are the features and benefits of the package.

• Offers members comprehensive In-Hospital benefits for healthcare services.
• Comprehensive out-of-hospital benefits for healthcare services.
• Family Practitioner Network Extender Benefit once the day-to-day block benefit is exhausted.
• 41 additional non-PMB chronic conditions.
• Access to public facilities.

What is a GEMS medical aid calculator?

The GEMS medical aid calculator is a webpage that helps you know your total monthly contribution for the GEMS medical aid option you select. The total contribution is based on the family size and income band information you provided.

GEMS medical aid application process

To become a member of this government medical aid scheme:

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• Visit the GEMS website.
• Click "Login."
• Click "member."
• You will be directed to another webpage.
• Click "JOIN GEMS."
• Compete the questions and click "Check if I qualify."
• If you qualify to be a GEMS member, the system will give you more prompts to follow until you complete the registration process.

Where can you find GEMS medical aid application forms?

All important GEMS application forms are available for download on the GEMS website.

How do you contact GEMS?

For any inquiry, use the following GEMS contact details:

GEMS call center

• Postal address: Private Bag X782, CAPE TOWN, 8000
• Street address: GEMS (administrative), 61 St George's Mall, Cape Town
• Phone: 086 000 4367
• GEMS email address: enquiries@gems.gov.za
• Monday - Friday: 08h00 - 17h00
• Saturday: 08h00 - 12h00

Emergency number

• 080 044 4367
• Monday - Sunday
• 24 hours

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GEMS medical aid contact number

• 086 043 6777
• Monday - Friday
• 09h00 - 16h00

Confidential fraud hotline

• 080 021 2202
• gems@thehotline.co.za
• Monday - Friday
• 09h00 - 16h00

Confidential HIV/AIDS

• 086 043 6736
• 083 843 6764

GEMS medical aid Polokwane contact numbers

• Address: 54 Market St, Polokwane Central, Polokwane, 0700, South Africa

What is GEMS WhatsApp number?

GEMS (the Government Employees Medical Scheme) has no WhatsApp number.

Are GEMS offices open?

GEMS has 19 walk-in centers in South Africa, two in every province. The operating hours of the regional offices are Monday – Friday from 08:00 to 17:00 and Saturday from 08:00 to 12:00.

What does the GEMS scheme cover?

GEMS medical aid plans provide comprehensive out-of-hospital and in-hospital benefits. In addition, all level 1-5 members can have a 100% subsidy from their employers. The GEMS scheme also gives members access to a network of hospitals and unlimited GP and specialist consultations.

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What are the benefits of gems in 2024?

This government medical aid scheme has many benefits. For instance, GEMS members benefit from income-band-rated contributions. Also, GEMS' average family contribution is 25% lower than most of its competitors.

What are GEMS options?

The GEMS medical aid scheme has six options: Tanzanite One, Beryl, Ruby, Emerald Value, Emerald, and Onyx. Civil servants in South Africa can choose any option, depending on their income and financial capabilities.

Which is the cheapest GEMS option?

Tanzanite One is the cheapest option. Its price starts from R1 363 monthly for the principal member, R1 077 for an additional adult member, and R587 for an additional child member.

What is the difference between Ruby and Emerald GEMS?

Ruby is less costly than the Emerald GEMS medical aid option. A principal member's contribution starts from R3 180 monthly under the Ruby option, while the Emerald option's contribution starts from R3 554 monthly.

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Who qualifies as an adult-dependent in GEMS South Africa?

The following are deemed as adult dependents under South Africa's GEMS medical aid scheme:

• A spouse or partner
• A child over the age of 21 who is not a full-time student, financially and otherwise dependent on the principal member
• An immediate family member for whom the principal member is liable for family care and support

Who qualifies as a child-dependent in GEMS South Africa?

The following are deemed as child dependents under South Africa's GEMS medical aid scheme:

• A principal member's natural or legally adopted child who is under the age of 21
• A child as described above, but of any age, who is mentally or physically handicapped
• A child as described above, but who is between the ages of 21 and 27 and registered as a full-time student at a registered tertiary institution

What do you do if you need an ambulance service?

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GEMS medical aid scheme members must call 0800 44 4367 in all medical emergencies.

Metastatic cancer members and dependents of GEMS have access to the Palliative Care Program

What if you stay in the hospital longer than the approved stay?

Ensure the hospital case manager, your doctor, or a family member informs GEMS of the extended stay on 0860 00 4367. GEMS will approve the extra days if there is a valid clinical reason for the stay.

Does the GEMS scheme cover dental treatment in the hospital?

GEMS funds impacted teeth removal from the overall annual limit when the procedure is authorized at 100% of the scheme rate and 200% when done in the rooms. It also pays for conscious dental sedation in rooms for children up to age nine.

Does GEMS cover dentures for Tanzanite One and Beryl members?

The GEMS dental benefit for Beryl and Tanzanite One members allows a set of plastic dentures per beneficiary every four years. Only members and beneficiaries over 21 years old qualify for this benefit, and no benefit is available for metal frame dentures.

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Does GEMS offer benefits for Orthodontic treatment?

Benefits for orthodontic treatment are only available to GEMS beneficiaries under the age of 21 on the Ruby, Emerald, Emerald Value, and Onyx options. It is a once-in-a-lifetime benefit per beneficiary. GEMS has no separate benefit limit for orthodontic treatment; all claims are payable from the available dental financial limit.

Does GEMS cover root canal treatment?

Root canal treatment is covered on all GEMS options. For Beryl and Tanzanite One members, this benefit is limited to one root canal treatment per beneficiary per year, and services must be provided by a dentist who is part of the GEMS dental network. For all other options, this benefit is subject to the annual limit for out-of-hospital dental services.

What happens if your authorized benefit changes?

If your authorized chronic medicine changes in any way, you need to communicate the change to GEMS. The quickest way is for the prescribing doctor or dispensing pharmacist to contact the clinical staff on the Service Provider Line (0860 436 777). The medicine change will be processed within five days.

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What is the best medical aid in South Africa?

GEMS, Discovery Health, Momentum, Fedhealth, and Bonitas are among the most popular medical aid schemes in South Africa.

What is the cheapest medical aid in SA?

Momentum Health, NetCare, Fedhealth, Discovery Health, and Bonita have affordable medical aid coverage for R500 and less.

GEMS medical aid scheme has different options, and prices are tailored to enable civil servants with varying income levels to get medical coverage. Nonetheless, the total contribution is based on the family size and income band information you provided. So, you can be in a cheaper GEMS option but pay more than someone in an expensive option.

DISCLAIMER: This article is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional advice or help and should not be relied on to make decisions of any kind. Any action you take upon the information presented in this article is strictly at your own risk and responsibility!

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While no one ever plans to find themselves in a crisis, occurrences such as fires, break-ins, medical emergencies, and earthquakes can happen at any time. Hence, having the correct emergency numbers to call for help is essential.

Source: Briefly News