Sapphire
Using YOUR benefits ›
How to make use of healthcare services
Sapphire and Beryl options offer members comprehensive benefits through a network of healthcare providers. As a member, you must remember to always access a healthcare provider who belongs to the GEMS Network or you may find yourself in a situation where your medical expenses are not paid for by GEMS. To find a network doctor or other healthcare service provider in your area, call the Call Centre on 0860 00 4367 and choose the Sapphire and Beryl option. Access to your benefits will be explained by the Call Centre agent.
How to access your benefits
Which doctors, dentists or optometrists can I go to?
You may only go to doctors, dentists or optometrists who are on the GEMS Network. The network is very large and there are many doctors, optometrists and dentists throughout South Africa. To find the doctor, dentist or optometrist close to you, please contact GEMS on 0860 00 4367 and choose the Sapphire and Beryl option or click here.
Your Network healthcare service provider can also be identified by a GEMS Network notice in their surgery.
You can also use the Friends of GEMS service. These healthcare service providers have agreed not to charge GEMS members any surcharges and co-payments for services delivered to our members. You can find a GEMS Friend by sending an SMS containing your member number, the service you need and the place you prefer to 33489. You will receive and immediate response with the required details.
SMS's are competitively priced at R1.50 and the response SMS is included. Please note: Your account will not be paid if you visit a healthcare service provider who is not on the GEMS Network in cases where a network provider is available.
Click here for more information about ›
What medication does GEMS pay for (Formulary)?
You can also visit the Formulary Check service to conduct a search.
What does GEMS not pay for?
Click below to access the Exclusions and Limitations.
Forms ›
Benefits 2010 ›
Cost of membership for 2010 ›
Contribution tables
As always, GEMS strives to bring you the best possible healthcare benefits to suit your pocket. Offering you more choices is what our commitment to you is all about. There is a benefit option perfect for you and your family's healthcare needs and
your pocket!
These are the total monthly contributions for each option and do not reflect any applicable employer subsidy. If you are eligible for a subsidy, the employer will pay a portion of the contribution reflected in the table and the employee the balance. If you are on salary level 1-5 and join the Sapphire option, you may be eligible for a 100% subsidy from the employer. Your HR Practitioner will be able to assist you with this.
| Salary Band | Member
| Adult | Child |
R0 – R3300
| R464 | R340 | R196
|
| R3301 - R5500 | R488 | R360 | R212 |
| R5501 - R8800 | R520 | R380 | R224 |
| R8801 + | R576 | R452 | R272 |
Contribution statementsA contribution statement is issued to each member on a monthly and quarterly basis and summarises your monthly contribution payments and outstanding payments. This statement helps you to ensure that your contributions are always up to date.
Managing arrear contributions
Arrears contributions can be caused by the following:
Your medical deduction has not been implemented.
Your salary increase was backdated and this increase moved you into a higher contribution category.
You added a dependant and this change was not implemented on time.
You moved to another department that has not implemented your medical deductions yet.
Your contract expired and your new contract has not been captured.
GEMS will send you a letter confirming the amount of your medical contribution arrears. You will also receive a monthly contribution statement if your account is in arrears.
Note: You can approach your HR Practitioner to assist you with the repayment terms of any arrears.
You have to manage any arrears contribution, because arrears contributions could lead to your healthcare benefits being suspended.
Understanding the different codes on your salary statementVarious salary codes are used for medical scheme deductions. Below is an explanation of what they mean:
- 0005 - Normal medical aid deduction: This amount would be the monthly contribution.
- 0006 - Arrears deduction implemented via GEMS: This amount is for medical arrears that were incurred within a three-month period. The employee payroll automatically calculates the amount which the employee can afford and will
either deduct the arrears once-off or spread the arrears over a few months.
- 0189 - Manual arrear implementation via HR Practitioner: This amount is for any arrears which could not be implemented automatically via the employee payroll (more than three months) and is manually implemented by your
HR Practitioner.
