GEMS Mandate

The Government Employees Medical Scheme (GEMS) was registered with effect from 1 January 2005 to address the challenges in respect of the current provision of medical assistance to public service employees by government. The development and implementation of GEMS has been informed by substantial bodies of research, sound data analyses and intense consideration by Cabinet. The progress that has been made during the implementation of GEMS is further evidence of government's desire to apply unique and innovative measures to ensure that all our employees are awarded equitable access to their conditions of service in the public service. The implementation of GEMS is a positive development that clearly positions government as an employer of choice that truly cares for the health and wellbeing of its employees.

Before GEMS ›

• Many employees could not afford medical cover;
• The cost of belonging to a medical scheme has continuously become more expensive;
• Employees have not received the maximum value for their money;
• There has been little integration with the public health system;
• Employees have not had scheme products developed specifically for them and by them; and
• The employer, who contributes greatly to its employees' scheme payments, has not had the opportunity to participate in the management of the medical schemes public service employees are enrolled on.

In 2002, Cabinet approved a framework policy on a restricted medical scheme for further development by an interdepartmental working group (Departments of Public Service and Administration, National Treasury, Health, Education, Correctional Services and SAPS).

The approved framework policy centered on the following principles ›

• Equity where employees have equal access to the most extensive set of equal basic benefits under equitable remuneration structures, subject to affordability);
• Efficiency in respect of costs and delivery of benefits; and
• Differentiation where employees opting for more extensive cover have equal access to such higher benefits subject to their needs.

On 3 November 2004 after careful consideration of the findings of a detailed feasibility study conducted in the same year, Cabinet approved that the Department of Public Service continue work on the:

• Registration of a restricted membership medical scheme for public service employees;
• The establishment of the scheme's governance and management structure;
• The development of a member enrolment strategy in consultation with National Treasury; and
• Enhancing an understanding of the possible risks and costs involved.

The implementation of GEMS sees the fulfilment of government's stated policy objectives regarding the restructuring of the medical assistance dispensation. GEMS' achieves the promotion of equitable access to comprehensive and affordable healthcare benefits by all public service employees and promotes greater access to this employee benefit by our lower income earners. The implementation of GEMS also sets an example to other employers by demonstrating that innovative medical benefits can be made available to all employees.

Implementing GEMS affords government the opportunity to exercise greater control over the large sums of money it currently contributes to the private healthcare sector and also over the selection and quality of healthcare benefits that its employees elect to contribute towards. Government will be able to directly influence the governance of the schemes it contributes toward because it will now be represented on the board of trustees of the scheme and it will be represented during the annual revision of benefits and contributions.

Government will be empowered through GEMS to provide more employees with an opportunity to improve their health and well being - in turn impacting positively on improved productivity levels in the public service.

Additionally, GEMS also achieves unique synergies with the work currently being performed by the Department of Health. GEMS may ultimately see the enrolment of an additional 1 million medical scheme beneficiaries, through the promotion of greater access to the employer subsidy by 380 000 of our employees and their families who are currently not enrolled on a medical scheme. The introduction of these additional beneficiaries into the medical scheme environment will result in a reduced public sector patient load and the reciprocal reduction in the demand on the public sector's finite resources. By enrolling members on GEMS' Sapphire option, additional revenue streams for public healthcare facilities and the public private partnerships will be created.

Lastly, the implementation of GEMS supports the work performed by the Department of Health with regard to Social Health Insurance and the establishment of the Risk Equalisation Fund.

Government believes that it is imperative that equitable access to comprehensive healthcare benefits by our employees is promoted, as this will result in:

• The expansion of medical scheme beneficiaries and the increased revenue generated in the private healthcare sector; and
• A reduction in the pressure on many of our public sector facilities that so many of our citizens are dependent on for the provision