About the GEMS Network


GEMS has a network of healthcare providers consisting of General Practitioners (GPs), specialists, pharmacies, dentists and optometrists who have promised to deliver quality healthcare at Scheme rates to our members. This means you will not have to pay any amounts above the set amount we have agreed with the healthcare providers.  

Visiting a GEMS Network healthcare provider is one of the ways that we can ensure you receive proper care. In addition, there are many advantages to visiting a GEMS Network provider:

  • You will not have to pay any out-of-pocket consultation expenses.
  • Your GEMS Network provider has committed to providing excellent quality care to you at Scheme Rates, and not to charge you any co-payments or additional costs.
  • All GEMS Network providers are willing to have their practice evaluated (peer reviewed) and, where necessary, to accept guidance by their colleagues (peer mentoring) to improve their practices.
  • Providers who are evaluated and achieve the highest status are rewarded with a higher consultation fee - at no additional cost to you.

Enhanced fees: GPs on the Ruby, Emerald and Onyx (REO) GP network are profiled and based on their category, can qualify for an enhanced fee.

  • Category 1 GEMS REO GP network practices will qualify for an enhanced consultation fee.
  • Category 2 practices are required to achieve the benchmarks indicated in the specified GEMS Focus Measures in order to qualify for an enhanced fee.

It is easy to identify a GEMS Network provider, as they will display a GEMS Network logo in their premises. You can also use the "Find a Network provider" tool to search for a GEMS Network provider in your town or call the GEMS Call Centre on 0860 00 4367 for assistance.

Please note

  • If you are a member of the Sapphire, Beryl or Emerald Value options, ensure that your provider is a member of the GEMS Network before using the provider's services.
  • The 'Find a network provider' search function does not specify if a dental practitioner is a designated service provider for the Sapphire and Beryl options. Consult the SB providers list or call the GEMS Call Centre on 0860 00 4367 for assistance.
  • The General Practitioner plays a vital role in providing you with quality healthcare. To help your General Practitioner (GP) keep track of your healthcare, it is important that you consult the same GP for all your healthcare needs. Click here for more information.

Remember
Your GEMS Network provider has agreed to provide you with excellent service and care. It is your right as a GEMS member to inform us if your service provider does not comply with the GEMS Network requirements (for example, if your Network provider makes you pay co-payments out of your own pocket).

These providers can be reported by calling the GEMS Fraud line on 0800 21 22 02, sending an email to gems@thehotline.co.za or sending a fax to 086 726 1681. Information can also be posted to: The Fraud Services Manager, PO Box 21076, Valhalla, 0137.