Thank you for visiting us online. Sign in here to access your membership information.
On this secure website you can:
Any queries? Please provide your feedback so that we can make your GEMS online experience
a pleasant one.
As a healthcare service provider, if you provide services to any of our members, you can register on our secure website to:
Any queries? Please provide your feedback so that we can make your GEMS online experience a pleasant one.
DMA is the first tool of its kind in South Africa - providing employers with easy, 24/7 access to the membership data of their entire employer group or branch - through the Internet. DMA allows you to:
Any queries? Please provide feedback so that we can make your GEMS online experience a pleasant one.
Click here to view your Claims Guide or go through the following questions for detailed information on how you can submit all your claims.
Who can claim?
The member or the healthcare service provider (for example, a doctor, pharmacy or hospital) can make a claim.
How is the claim processed?
The Claims Department receives the claim and assesses it according to the Scheme Rules. If the Scheme Rules allow, the claim will then be paid.
Sometimes additional information is required from you or your healthcare service provider when assessing claims. If this information is not available, some claims may not be paid in part or in full.
When are claims paid?
Twice a month.
Are medicine claims processed immediately?
Your pharmacy can send medicine claims to us electronically at the point of sale. The Scheme Rules will be applied immediately, so you will find out if GEMS will pay for the medicine right away. This means that you will get your medicine immediately, if you have available benefits, GEMS will pay for the medicine without you having to pay for it in cash.
Reasons why claims are rejected (not paid)
Incorrect member or dependant information
No pre-authorisation (PAR) number for treatments such as hospitalisation and oncology
No benefits are available
Claims we receive for treatment after a member has resigned from the Public Service or from GEMS
For all GEMS options there are specific conditions and treatment facilities that are not paid for, in line with the Medical Schemes Act. The items or procedures that are not covered by the Scheme are called Scheme exclusions. Members must make sure that the procedures, treatments or medicine they receive will be paid for before getting them because GEMS will not pay for excluded services or items. Members will be responsible for paying those costs. Scheme exclusions are listed in detail in Rule 16 and Annexure E of the Scheme Rules.
Please remember that claims that are submitted incorrectly will not be paid. You will receive a claims statement explaining the
reason why your claim has not been paid. Your claim will be returned for you or your healthcare service provider to provide the
correct information and resubmit. Submitting your claim incorrectly will cost you time - so, save yourself the trouble and get it right the first time.
What information must be on your claims?
Submit your claims correctly
You can also deliver your claims to one of our 18 walk-in centres across the country.
Claims statement explained
Click here to understand your claims statement.
When you have paid a healthcare service provider for a service, you may claim a refund from the Scheme. Whether we pay the claim, and how much we pay, will be determined by the Scheme Rules. We make refund payments to members electronically, so you need to make sure that we have your updated, correct banking details.
We need the following banking information:
Please fax this information to 0861 00 4367 or send an email to email@example.com, using your member number as a reference. You can also deliver the information to one of our walk-in centres or post it to: GEMS, Private Bag X782, Cape Town, 8000.
Click here to view your Claims Guide.
Claims alert SMS
Members can receive claim alert SMSs each time GEMS processes their claims. These SMSs acknowledges the receipt of claims but it is not a guarantee of payment. Ensure that you read your claim statement to see if your claim was paid or not. To receive claim alert SMSs, please call 0860 00 4367 and make sure that we have your current cellphone number.
Remember: If you receive a claim alert SMS for a claim you are not aware of, please report it to the Scheme as soon possible. Call us on 0860 00 4367.
Download various forms relating to your membership in easy-to-use PDF format. Click Here >