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What is the government Medical Aid Scheme ?

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As of the first of January 2006 the South African government's Medical Aid Scheme - Gems - became operational.

The government employees medical aid scheme's first claims were paid out in mid-January.

So what does this all mean, and what is the Government Employees Medical Scheme?

GEMS is a government medical aid scheme aimed at all government employees. This means that if you are a public service employee, then you will be able to join GEMS with a subsidy from the government.

This also implies that all civil servants who were previously on other private medical aid schemes will be moved over to GEMS, and that servants previously without cover get the opportunity to be covered.

The government employee medical scheme enrollment strategy is an incremental system, which will be targeting those employees not covered at all first.

What are the implications of the Government employees medical scheme?

"When you say medical insurance, people always think private sector. We need to attract more people into the system so that they can pay for services and we can use the money to improve the public hospitals,"

The main implication is that civil servants who previously made use of free public health services will now have to pay for it.

For other open medical aid schemes it means that they will be losing in excess of 200 000 members to GEMS.

The benefits of this is does not go to you, the member of the medical scheme, but to a much broader one - public health. As we all know, the public healthcare system is grossly in need of a pick-up. They are understaffed and under resourced.

The scheme will bring much needed funds into the system, as well as clear up the pool of people using free health care services, thus allowing for new people to make use of it.

Will I have to use public health care services when i become a gems member?

The Government Employees medical scheme will give you the choice between going into private care, or public care. You are under no obligation to use public hospitals if you don't want to, unless you are on their cheapest product, which only allows for public hospital care.

However, the Department of Health encourages everyone to use public hospitals rather than private hospitals. Minister Geraldine Fraser-Moleketi leads by example and often makes use of public hospitals such as Pretoria Academic Hospital and the Johannesburg Hospital.

You are not forced to do this though, and should you choose, you may go to private care.

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Products offered by gems

The Government Employee Medical Fund offers a range of products - Saphire, Beryl, Ruby, Emerald and Onyx. The products are named after gemstones, and as the stones themselves range from least precious to most precious, so too does the products range from cheapest to most expensive.

Limitations of gems services

You are restricted to the services provided by the winners of the tenders that GEMS established. For example, if you need to visit a doctor, then you will only be able to visit a doctor who is a part of the PrimeCure network.

They assure us that all their bid winners are nationally networked and you will be in reach of the services.

Can you provide broker services on the government employees medical scheme?

No, unfortunately the Government Employees Medical Aid Scheme does not allow for brokers services at all. This has the side-benefit that no broker fees are applicable!

Where can I get more information on gems?

For more information you can visit the GEMS website, or give them a call on 0860 00 4367

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