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Sapphire Beryl Ruby Emerald Emerald Onyx

Sapphire


The Sapphire option is an entry-level network benefit option that provides:

  • Out-of-hospital care such as visits to the doctor, dentist and optometrist
  • Maternity care at private facilities
  • In-hospital cover at public facilities.

Important things to remember about the Sapphire option

  • Always access a healthcare provider who belongs to the GEMS Network. This will prevent you from having to pay for treatment or an appointment out of your own pocket. Click here to find a GEMS Network doctor in your area or call the GEMS Call Centre on 0860 00 4367.
  • You are encouraged to nominate a General Practitioner (GP), although penalties will not apply, on the GEMS Sapphire and Beryl network, who you will consult for all your doctor visits.
  • If you visit a non-network GP your consultation will be paid from your non-nominated benefit. This benefit allows three visits per family per year to a General Practitioner (GP) who is a non-network GP. Funding will be 80% of the Scheme rate and you will have to pay a co-payment of 20% from your own pocket. If your non-nominated benefit is depleted, and you consult a non-nominated GP, your claim will not be paid by the Scheme. You are required to pay the claim and submit the claim with proof of payment for reimbursement
  • All visits to a specialist or allied healthcare provider (such as a physiotherapist or speech therapist) must be referred by your nominated GP. Your nominated GP must also phone the GEMS Call Centre and obtain pre-authorisation before you can visit a specialist or allied healthcare provider.
  • Pathology and radiology tests (blood tests and x-rays) must be referred by your nominated GP. These tests must be in line with the GEMS formulary (list of approved tests or services) for Sapphire.

Your 2017 benefits

View your 2017 benefit guide.

All about the GEMS Network

The GEMS Network is made up of FPs, specialists, optometrists, dentists and pharmacies who have agreed to provide excellent quality healthcare to GEMS members at Scheme rates. You will not be charged any co-payments or additional costs by healthcare providers that are on the network. A network provider will only charge a co-payment if your benefits are exhausted for the service or benefit you want to access, or if you did not follow certain Scheme rules. For example, if you did not get pre-authorisation for a hospital admission as required by the rules, you will have to pay a penalty fee even if that hospital is on the network. All GEMS Network providers will display a GEMS Network logo/sticker in their practice window or door, making it easy for you to identify them.

Make sure that your GEMS Network providers are always your first port of call. They are there to be the coordinator of your healthcare, providing you with the best quality healthcare and value for money. Click here to find a GEMS Network doctor in your area or call the GEMS Call Centre on 0860 00 4367.

We plan to introduce anaesthetist, physician and psychiatrist networks in the course of 2016. Please look out for communication on this later in the year.

Disease Management Programmes

What medicine does GEMS pay for (Formulary)?

What does GEMS not pay for?

Click here to see what GEMS does not pay for.

Forms

Cost of membership for 2017

Contributions (how much you pay each month to be a member of GEMS)

As always, GEMS aims to bring you the best possible healthcare benefits to suit your needs. Offering you more choices is what our commitment to you is about.

The contributions in the table below do not include employer subsidies. In some cases, you might qualify for a subsidy from your employer. A subsidy is an amount your employer pays towards the cost of being covered by GEMS. If you qualify for a subsidy, the employer will pay a portion of the contribution each month and you will pay the rest. You must find out about the subsidy from your employer.

If you have any questions about your subsidy, you should discuss them with your Human Resources (HR) Department. A useful contribution calculator will help you to work out your monthly contributions, if you are employed in the public service.

Salary BandMember
AdultChild
R0 - R7 897
R877R657R371
R7 897.01 - R11 081R919R697R400
R11 081.01 - R18 983R976R733R424
R18 983.01 +R1086R871R511

Note:

Salary column: This reflects the monthly salary amount before tax or other benefits are deducted.

Member column: This column shows how much the principal member, who is the public service employee registered with GEMS, has to pay.

Adult column: This oclumn shows how much you have to pay for your adult dependants.

Child column: This column shows how much you have to pay for a child dependant. GEMS covers children up to the age of 21, unless the child is mentally or physically disabled or is below 28 years of age and is a student registered at a recognised educational instutution.

Contribution statements

We send a contribution statement to members who owe money to GEMS on a monthly basis. We also send a contribution statement to all members on a quarterly basis. The contribution statement sets out your monthly contribution payment and any money that you owe to GEMS. This statement helps you to check that your contributions are always up-to-date.

Managing arrear contributions

You might be behind in your payment to GEMS if any of the following happen:

  • Your employer has not deducted your monthly contribution costs from your salary. This may happen to new members when the membership start date is captured after the date of the monthly deductions for that particular month. This might also happen if you move between departments.
  • Your salary increase was backdated and this increase moved you into a higher contribution category.
  • You added a dependant, but the additional contribution for this new dependant was not taken into account on time for the next contribution payment.
  • Your contract ended and your new contract was not active in time for the next payment.

GEMS will send you a letter confirming the amount that you owe us. You will also receive a monthly contribution statement if your payments are behind.

If you need help with paying the contributions you owe, please contact the Scheme or ask your HR Department to help you with the repayment terms.

Remember: Your annual contribution increases are effected in January and may be increased with your annual salary increase. It is your responsibility to ensure that your contributions are paid monthly and are up to date.

Benefit Options Enquiries >

0860 00 4367 (Call Centre) enquiries@gems.gov.za More Contacts >