GEMS Medical Aid schemes: Get a detailed overview for 2022

GEMS Medical Aid schemes: Get a detailed overview for 2022

The Government Employees Medical Scheme (GEMS) is a South African restricted medical scheme that offers numerous, affordable, accessible benefits to public service employees and their nominated beneficiaries. The scheme has more than 700,000 members and about 2 million beneficiaries. What are the GEMS medical aid options and prices in 2022.

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GEMS options and prices
The GEMS logo. Photo: @GEMS_Number1
Source: Instagram

The scheme currently has six packages, all priced differently to cater to the needs of the different earning levels amongst public service employees.

The different GEMS medical aid options and prices

Here is a look at the six GEMS options and prices one can choose from when getting a medical cover.

Tanzanite One

GEMS medical aid options
The Tanzanite One prices. Photo: legit.ng
Source: Original

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This option was previously known as Sapphire and is designed to be the most affordable of all GEMS medical aid options in 2022. This entry-level package is tailored for employees in levels 1-5 with benefits subject to specialist referral rules and network general physician nomination.

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Here is a look at the features of Tanzanite One.

  • 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!

Beryl

GEMS medical aid plans
The Beryl option premiums. Photo: legit.ng
Source: Original

This is a slightly pricier entry-level package designed for workers with low to medium healthcare needs. Here is a look at its features.

  • 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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Ruby

GEMS Medical Aid
The Ruby option premiums. Photo: legit.ng
Source: Original

Ruby is a mid-level benefit option tailored for public service employees with limited to average healthcare needs who wish to enjoy a personal medical savings account. 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 benefit 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

Emerald Value

GEMS medical aid options in 2022
The Emerald Value package premiums. Photo: legit.ng
Source: Original

Emerald Value is an efficiency-discounted option of the Emerald package. It is tailored for members with average to above-average healthcare needs. 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, which is 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 on 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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Emerald

GEMS medical aid options
The Emerald Value option premiums. Photo: legit.ng
Source: Original

Emerald is a high-level option tailored for members with average to above-average healthcare needs. Here are the package's main features.

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

Onyx

GEMS options
The Onyx package premiums. Photo: legit.ng
Source: Original

Onyx is a top-level benefit option tailored for members with above-average to extensive healthcare needs. 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 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 do I do if I need an ambulance service?

You or the person with you must call 0800 44 4367 in all medical emergencies.

What happens if my 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 5 days.

Which is the cheapest GEMS option?

Tanzanite One is the cheapest option, starting at R1,186 for the principal member.

Who qualifies as an adult dependant?

Here are the three scenarios that qualify one as an adult dependent under GEMS.

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

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Does the GEMS scheme cover dental treatment in the hospital?

GEMS medical aid options in 2022
A dentist's operation area. Photo: pixabay.com, @StockSnap
Source: UGC

Yes. However, keep in mind that hospitalization and dental treatment under general anaesthetic are allowed only for the removal of impacted teeth, severe trauma (PMBs) or patients aged below six years.

Who qualifies as a child dependent?

Here are the three scenarios that qualify one as a child dependent under GEMS.

  • 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.
  • 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.

What are GEMS options?

They are the different packages that include varying benefits and costs. Here are the six options available under the GEMS scheme.

  • Tanzanite One.
  • Beryl
  • Ruby
  • Emerald Value
  • Emerald
  • Onyx

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Does GEMS pay for Covid testing?

Yes, your GEMS scheme will cover Covid testing. Keep in mind that the test must be clinically appropriate, meaning you will have to be screened by a nurse or doctor, who will then recommend a test.

The different GEMS medical aid options and prices make it possible for any public service employee to get medical coverage. The six available options vary in the premium contribution and benefits list. Still, each package is handy for the principal and their beneficiaries.

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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