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How to submit a medical claim


When submitting a claim, make sure the following information is on the healthcare service provider's invoice or claim:
  • Your member number
  • Your benefit option
  • Your surname and initials
  • The patient's name and beneficiary code as it appears on your membership card
  • The name and practice number of the service provider
  • The date of service
  • The nature and cost of treatment
  • The pre-authorisation number, if applicable
  • The tariff code
  • The relevant ICD-10 code
  • Your signature to confirm that the account is valid (for paper claims).
How do I submit claims?
GEMS has made it easy for you to submit your claim. You can submit your claim by using the following channels:

Forms >

Download various forms relating to your membership in easy-to-use PDF format. Click Here >

Member Enquiries >

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