GEMS has a network of healthcare service providers consisting of general practitioners (GP), pharmacies, dentists and optometrists who have promised to deliver quality healthcare to GEMS members. Healthcare service providers on the GEMS Network have agreed to provide quality healthcare to GEMS members at Scheme rates. This means you will not have to pay any amounts above the set amount we have agreed with them. All Network healthcare service providers who are part of the Sapphire and Beryl Network will display a GEMS Network logo/sticker on their window or door, making it easy for you to identify them.

You can also click here to find a GEMS Network provider.

Members on the Beryl option need to keep the following in mind:

• Please ensure that your GP, optometrist or dentist is on the GEMS Network before you visit them. This will ensure that you do not have to pay out of your pocket for the appointment or treatment.
• Visits to a specialist or allied healthcare provider (such as a physiotherapist or speech therapist) need to be referred by your Network GP, who will obtain authorisation from the GEMS Call Centre.
• Pathology and radiology tests (blood tests and x-rays) must be in line with the GEMS formulary (list of approved tests or services) for Sapphire and Beryl and also require referral from your Network GP.
• GEMS will be introducing a pathology and radiology claims validation service to assist in ensuring that these claims are managed appropriately when you claim.

Click here for more information about ›

• Out-of-hospital benefits
• Chronic medicine programme
• HIV/AIDS management
• Oncology management
• Optometry management
• Dental management
• Maternity Programme
• Hospital management

What medicine does GEMS pay for (Formulary)?

Acute Medicine Formulary - Sapphire and Beryl

Chronic Medicine Formulary - Sapphire and Beryl

You can also visit the Formulary Check service to conduct a search.

What does GEMS not pay for?

Click here to see what GEMS does not pay for.

Forms ›

• Application Form>
• Chronic Medicine Application form>
• HIV Disease Management Form>

Benefits 2013 ›

Download the Benefits schedule for 2013

Cost of membership for 2013

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.

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 full-time 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 might 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 and we did not take account of this change in time for the next 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.