FAQs

Select a section... Membership & Dependants Questions about the employer's subsidy Common questions and procedures

Membership & Dependants ›

Who can join GEMS?

Employees or former employees of national departments, provincial administrations, provincial departments and organisational components contemplated in section 7(2) of the Public Service Act, 1994 may join GEMS. As the principal member you may apply to register your dependants on the Scheme. Employees of the South African National Defense Force, the National Intelligence Agency and the South African Secret Services are disqualified from joining GEMS, including any department where the conditions of service do not allow their enrolment on GEMS.

Why join GEMS

GEMS members enjoy access to benefits that are tailor-made for government employees. Contributions are directed at paying for healthcare services rather than expensive administration. Well-established service providers are contracted to partner with GEMS in the delivery of services to members. GEMS members benefit from:

• Excellent healthcare benefits at affordable contribution rates
• Absolute privacy: Your medical information is always kept completely confidential - even from your employer
• Prompt and efficient claims payment every fortnight
• Regular member communications
• Friendly and efficient customer service
• Access to extensive medical care at private facilities of your choice
• A Disease Management Programme to manage the treatment and costs of ongoing illnesses
• A HIV/Aids Management Programme that gives you confidential care when you need it most
• An Emergency Medical Service that covers a wide area of South Africa

Is it compulsory for new permanent appointments to join GEMS or can they join any medical scheme of choice and be subsidised?

New appointees with an appointment date of 1 July 2006 or later will only be subsidised on GEMS. They will not qualify for an employer subsidy if they join an open medical scheme.

Can contract workers join GEMS?

Contract employees whose term of appointment is at least 6 months may join GEMS. Note that some contract employees are remunerated by means of all-inclusive remuneration packages, i.e. basic salary and a cash amount calculated as 37% of basic salary. PERSAL will not generate an employer subsidy when such a contract worker joins GEMS since the subsidy is already built into the remuneration package.

Who can join GEMS as dependants?

	Description of Dependant	Documentation required
1	Spouse	Completed dependant section on application form Note: If customary marriage, an affidavit from the member confirming the obligation towards the spouse.
2	Ex-spouse	Completed dependant section on application form, and Copy of legal obligation to provide medical support per divorce settlement.
3	Partner	Completed dependant section on application form, and Sworn affidavit confirming that the dependant is the member's life partner. (Sworn affidavit to be completed by member, partner and witness)
4	Child (biological, adopted, step or foster) with member's surname, under the age of 21	Completed dependant section on application form. Note: If the child's surname differs from the member's, an affidavit confirming the obligation towards the child and stating the reason for the difference is required. (Sworn affidavit to be completed by member)
5	Child (biological, adopted, step or foster) with member's surname, over the age of 21	Completed dependant section on application form, and If child is a student: Proof of full-time registration at a recognised tertiary institution and Affidavit from member confirming financial dependency If child is totally dependent due to mental or physical disability: Proof of disability from a medical practitioner (medical assessment report to be completed by medical practitioner) and Affidavit from member confirming the child is not in a state institution, and affidavit from member confirming financial dependency. If child is not a student nor disabled: Affidavit from member confirming financial dependency Note: If the child's surname differs from the member's, an affidavit confirming the obligation towards the child and stating the reason for the difference is required. (Sworn affidavit to be completed by member)
6	Parent, parent-in-law, grandparent or grandparent-in-law	Completed dependant section on application form, and Affidavit from member confirming financial dependency of the beneficiaries on the member. Note: Parents-in-law and Grandparents-in-law may only be registered if spouse is also registered as a beneficiary.
7	Grandchild	Completed dependant section on application form, and Proof of child support grant received by the member or the spouse, or Sworn affidavit confirming financial dependency of the grandchild on the member. (Sworn affidavit to be completed by member and biological parent, where applicable)
8	Sibling	Completed dependant section on application form, and Sworn affidavit confirming financial dependency of the sibling on the member. (Sworn affidavit to be completed by member) Note: Only the sibling of principal member may be registered as a beneficiary
9	Children of sibling	Completed dependant section on application form, and Sworn affidavit confirming financial dependency of niece/s and/or nephew on the member. (Sworn affidavit to be completed by member and sibling, where applicable) Note: Only children of sibling of principal member may be registered as a beneficiary

Why does GEMS check the eligibility of student dependants?

The annual dependant eligibility review process is an initiative aimed at protecting the interests of Scheme members. This process ensures that only eligible beneficiaries are registered and enjoy benefits according to the Scheme's rules.

In order to ensure that student dependants (who are 21 years and older but younger than 28) can stay registered on GEMS as child dependants and not pay adult contribution rates, members have to provide GEMS with the following documentation:

• An affidavit certifying financial dependency
• A letter that proves that the dependant is registered at a recognised tertiary institution

All affidavits and documents have to be certified by a commissioner of oaths.

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Questions about the employer subsidy ›

How does the medical aid subsidy work?

• The subsidy will be calculated at 75% of the total contributions, subject to the limits contained in Resolution 1 of 2007: Revised determination on Medical Subsidy in the Department of Public Service and Administration's (DPSA) circular 1 of 2007
  • The current limits (effective 1 March 2010) are R670 for a single principal member;
  • R1340 for a principal member and one dependant (effectively R670 for the first dependant)
  • R410 for the second dependant and each dependant thereafter, up to a maximum of R2570. Circular 17/12/P dated 9 March 2010 also contains the subsidy adjustments.
• The no worse off clause (that a member will receive the greatest of the rand value of the subsidy on 30/06/2006 or the subsidy calculated as 75% subject to the applicable limits) only applies if the member moves from his previous scheme to GEMS with no break in membership
• The subsidy will not result in a credit/refund to the member, as the subsidy is always limited to the applicable maximums, or the total contribution
• GEMS does not determine the subsidy receivable (these calculations are done by the employer)
• To determine the subsidy: Employee category subsidy structure:

  Employees appointed on or after 1 July 2006	An employer subsidy will only be paid if the employee becomes a member of GEMS The subsidy will be calculated as 75% of the total contribution, subject to the following maximum employer contribution: Member with 0 dependants R670 Member with 1 dependants R1 340 Member with 2 dependants R1 750 Member with 3 dependants R2 160 Member with 4 dependants R2 570
  Employees appointed prior to 1 July 2006 who did not receive an employer subsidy on 30 June 2006	An employer subsidy will only be paid if the employee becomes a member of GEMS The subsidy will be calculated as 75% of the total contribution, subject to the maximum employer contribution in 1 above
  Employees appointed prior to 1 July 2006 who received an employer subsidy on 30 June 2006 who want to join GEMS	The subsidy will be calculated as the greatest of: 75% of the total contribution, subject to the maximum employer contribution in 1 above Or The rand value of the employer subsidy received on 30 June 2006 ONLY IF there was no break in Scheme cover since 30 June 2006.
  Employees on salary level 1 to 5 who join GEMS on the Sapphire option	The subsidy will be calculated as 100% of the total contribution, subject to a limit of R2 570 (irrespective of the number of dependants)
  Employees appointed prior to 1 July 2006 who received an employer subsidy on 30 June 2006 who do not want to join GEMS	The subsidy currently received by the employee will continue unchanged

  It is important to remember that GEMS does not have any authority in respect of the employer subsidy and does not determine the value of the subsidy or the subsidy rules. The subsidy is determined by the Minister of Public Service and Administration through the collective bargaining processes in the Public Service coordinating Bargaining Council (PSCBC).
  
  Additional notes: The "no worse off" clause (that a member will receive the greatest of the rand value of the subsidy on 30/06/2006 or the subsidy calculated as 75% subject to the applicable limits) only applies if the member moves from his previous scheme to GEMS with no break in membership. The subsidy will not result in a credit/refund to the member, as the subsidy is always limited to the applicable maximums, or to the total contribution (member contribution and employer contribution).

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Common questions and procedures›

How can HR practitioners assist members with option changes?

• Five easy steps to change options
  • Carefully consider their medical aid needs
  • Select an option they know they can afford
  • Complete the option change form if they would like to change to another option
  • Check to see if all their personal details are still correct and amend if necessary
  • Fax the form back to us at 00861 00 4367.

How do we assist members to pay their medical aid arrears?

• No backdated amendments more than 3 months can be performed directly via Persal
  • Example: GEMS receives information for August 2009 where an employee had a salary increase backdated to 1 January 2009
  • GEMS can now only request the increased contribution as far back as 1 June 2009. The months of January until May fall outside the 3 month rule
  • Such amendments can still be deducted from an employee's salary via the implementation of an "0189" - Medical Arrears (Non Programmatically) deduction
• When a request is sent to a HR official to implement a 0189 deduction, a reconciliation statement will be provided, indicating the member portion as well as the subsidy portion of the outstanding amount
• The HR Practitioner can now consult with the employee and institute a salary deduction on behalf of the employee in accordance with their needs to repay the arrear amount
• Non-implementation of these may result in suspension of benefits and even termination of membership

What is a late notification of terminated service?

• GEMS members should be resigned from the Scheme on their last day of service in the following instances:
  • When they resign from the public service or
  • have passed away, or
  • when their contracts of employment expire and
  • when they are discharged for misconduct
• PERSAL controllers/users must therefore update the PERSAL system timeously in order to terminate GEMS medical deductions where a change in employment will render the employee ineligible for membership of GEMS.
• When termination of employment or death is done backdated on PERSAL (periods of between 6 to 12 months is common), it leads to a reclaim from the Department of all contributions already paid to GEMS for the number of months affected
• This practice results in debt being created as claims paid during the affected period will be reversed
• The member will be held liable for all claims paid after the termination of employment as the member was effectively ineligible for GEMS membership (closed medical scheme)

What is the correct reference that we should use when submitting medical deductions for employees?

• HR officials must ensure that the correct reference number (member number) is used on the member's salary
• The reference needs to be 7 digits long and only numeric in order to match the payment received from the Department to the correct member on the system GEMS uses to administer the medical aid
• When the incorrect reference is used it may result in payments allocated incorrectly or not allocated and rectified at a later stage. This in turn can lead to the member receiving a debt letter incorrectly
• It can also have an effect on changes in contributions (52 transactions) as transactions will be rejected by PERSAL because the references do not match

How do we manage medical deductions for staff with cost-to-company packages?

• When contract employees who are on 37% in lieu of benefits join GEMS they will not get the employer subsidy
• The system will by default put the indicator at "No"
• Should this person be employed in a permanent capacity, the employer contribution indicator needs to be changed to "Yes"
• The member will not receive a subsidy should the indicator remain at "No"