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The GEMS Benefit Options are tailor-made to suit varying employment levels. Use the diagram below to see which of our Benefit Options are right for you!
| Hospitals › | Medicines › | Options › | |
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Hospitalisation on the Sapphire option is limited to public (state) hospitals.
You need authorisation from GEMS and a referral from a doctor on the Prime Cure network before being admitted to hospital, except in medical emergencies. |
There is no limit on medication, provided that your Prime Cure network doctor prescribes medicines listed on the GEMS medicine formulary.
You can get your medicines either from a Prime Cure network doctor or a Prime Cure network pharmacy. |
Optometry: Get one pair of spectacles per beneficiary every 24 months.
Out-of-hospital benefits: Services include visits to GPs, dentists, optometrists, basic radiology, pathology and medicines. |
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Beryl provides private and public (state) hospital cover at hospitals on the Prime Cure hospital network.
Authorisation from GEMS and a referral from a doctor on the Prime Cure network are required before you are admitted to hospital, except in medical emergencies. |
There is no limit on medication, provided that your Prime Cure network doctor prescribes medicines listed on the GEMS medicine formulary.
You can get your medicines either from a Prime Cure network doctor or a Prime Cure network pharmacy. |
Out-of-hospital benefits: Services include visits to GPs, dentists, optometrists, basic radiology, pathology and medicines. Specialists: 3 consultations per beneficiary up to R1 323, and 5 per family up to R1 984,50. Optometry: 1 pair of spectacles, 4 boxes of disposable contact lenses or one pair of permanent lenses to the value of R771.50 per beneficiary. |
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Ruby members enjoy unlimited access to private hospitals, of which the benefit is payable at 100% of the Scheme rate.
Separate limits apply to: . Radiology . Oncology treatment . Transplants . Dialysis . Prosthesis . Selected applicances |
Chronic medication listed here are covered fully if obtained from the Chronic Medication DSP (Designated Service Provider) and if they are on the medicine formulary and the medicine price list.
You need to complete the chronic application form in order to access the chronic benefit. A benefit of R10 500 per beneficiary per year for non-PMB related day admissions to hospital has been introduced. |
Out-of-hospital benefits: Services are paid from a Personal Medical Savings Account (PMSA) which is 25% of contributions. This includes visits to GPs, specialists, dentists, opticians and other services. Unspent funds remain yours and carries over to the following year. Block benefit: There is a block benefit of R1 050 per family per year. Claims will be paid from this benefit if your PMSA is exhausted. |
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Emerald members enjoy unlimited access to private hospitals, of which the benefit is payable at 100% of the Scheme rate.
Separate limits apply to: . Radiology . Oncology treatment . Transplants . Dialysis . Prosthesis . Selected applicances |
A comprehensive chronic medicine benefit, as indicated here, is provided.
You need to complete the chronic application form in order to access this benefit. Medication is covered fully if obtained from the Chronic Medication DSP and if they are on the medicine formulary and the medicine price list. Limits of R6 615 per beneficiary and R13 320 per family apply. |
Block benefit: Certain out-of-hospital services are paid from this benefit. The block benefit is limited to R2 756 per beneficiary up to R5 512 per family per year. In addition, separate benefits are available for medicine, pathology, radiology, optical and specialised dentistry. |
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Onyx members enjoy unlimited access to private hospitals, of which the benefit is payable at 100% of the Scheme rate.
Separate limits apply to: . Radiology . Oncology treatment . Transplants . Dialysis . Prosthesis . Selected applicances |
A comprehensive chronic medicine benefit, as indicated here, is provided. You need to complete the chronic application form in order to access this benefit. Medication is covered fully if obtained from the Chronic Medication DSP and if they are on the medicine formulary and the medicine price list. Limits of R11 576 per beneficiary and R23 152 per family apply. |
Out-of-hospital benefits: An out-of-hospital contraceptive benefit, including intra uterine devices, has been introduced.
Block benefit: Certain out-of-hospital services are paid from the block benefit. The limits are R5 787 per beneficiary and R11 576 per family per year. Separate benefit limits apply for services such as GP consultations, acute and chronic medicine, contraceptive medicine, optical and dentistry. |
0860 00 4367 (Call Centre) enquiries@gems.gov.za More Contacts >
