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Status of the Scheme
The Government Employees Medical Scheme (GEMS) was registered on January 1, 2005, in accordance with the Medical Schemes Act 131 of 1998. The scheme reports to the Registrar of the Council for Medical Schemes and is defined as a body corporate that undertakes liability related to its members' healthcare benefits in exchange for receiving contributions. GEMS is a separate legal entity that does not form part of any Government department or public entity.
GEMS actively started to enrol members from January 2006. As GEMS is a restricted scheme for Government employees, only those employed within public service can become members. GEMS's enrolment strategy was approved by Cabinet.
By December 2012, GEMS had more than 660 000 principal members and over 1.8 million beneficiaries. The Scheme continues to grow by more than 8 500 members each month.
GEMS's operational structure consists of a Board of Trustees that directs the Scheme's activities, a Principal Officer (CEO) who implements the directives of the Board and a scheme executive that supports the Principal Officer in monitoring and managing the service levels and contractual obligations of outsourced services. Cabinet approved this operational structure in November 2004.
GEMS was initially governed by an Interim Board of Trustees (also known as the Steering Committee) that consisted of 11 persons from different sectors within the Public Service appointed by the Minister of Public Service and Administration.
The Board of Trustees comprises of 50% of those trustees elected by the members through a transparent and fair election, and 50% appointed by the Minister for Public Service and Administration. The trustees are authorised to perform the duties of the Board in accordance with the Scheme's rules.
GEMS offers its members five different benefit options, namely Sapphire, Beryl, Ruby, Emerald and Onyx. These benefit options are 10% to 25% less expensive, with similar or increased benefits, when compared to other medical schemes in the market.
Sapphire and Beryl are the entry-level options where cover is provided by designated provider networks. Sapphire was specifically designed to be inexpensive and it achieves this by providing out-of-hospital care at private facilities and in-hospital cover at public facilities. Beryl provides in-hospital cover at both public and private facilities. Ruby offers members a savings account for day-to-day medical expenses as well as a hospital plan. Emerald is the traditional option and has been designed to resemble the medical scheme plan most public service employees were enrolled on prior to the establishment of GEMS. Onyx is the top of the line, comprehensive option.
GEMS service providers
We have contracted a network of service providers who provide various administrative and operational services to ensure that you get access to quality healthcare. They are:
Together, these healthcare service providers provide a unique and powerful service offering to all GEMS members.
The GEMS pricing model is based on sound risk management principles that have carefully considered the risk profile of public service employees and makes use of conservative actuarial assumptions. Importantly, GEMS has not assumed the savings that can be realised through the use of the full collective purchasing power of public service employees. Public service employees are, furthermore, eligible for medical scheme subsidies provided by the employer (when joining GEMS) of 75% and, in some cases, even 100%, up to a limit of R2,760.