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Status of the Scheme

The Government Employees Medical Scheme (GEMS) was registered on January 1, 2005, in accordance with the Medical Schemes Act 131 of 1998.

The scheme reports to the Registrar of the Council for Medical Schemes and is defined as a body corporate that undertakes liability related to its members' healthcare benefits in exchange for receiving contributions.

GEMS is a separate legal entity that does not form part of any Government department or public entity.

Member enrolment

GEMS actively started to enrol members from January 2006. As GEMS is a restricted scheme for Government employees, only those employed within public service can become members.

GEMS's enrolment strategy was approved by Cabinet.

Scheme structure

GEMS's operational structure consists of a Board of Trustees that directs the Scheme's activities, a Principal Officer (CEO) who implements the directives of the Board and a scheme executive that supports the Principal Officer in monitoring and managing the service levels and contractual obligations of outsourced services.

Cabinet approved this operational structure in November 2004.

Governance structure

GEMS was initially governed by an Interim Board of Trustees (also known as the Steering Committee) that consisted of 11 persons from different sectors within the Public Service appointed by the Minister of Public Service and Administration.

The Board of Trustees comprises of 50% of those trustees elected by the members through a transparent and fair election, and 50% appointed by the Minister for Public Service and Administration.

The trustees are authorised to perform the duties of the Board in accordance with the Scheme's rules.

Pricing

The GEMS pricing model is based on sound risk management principles that have carefully considered the risk profile of public service employees and makes use of conservative actuarial assumptions.

Importantly, GEMS has not assumed the savings that can be realised through the use of the full collective purchasing power of public service employees.

Public service employees are, furthermore, eligible for medical scheme subsidies provided by the employer (when joining GEMS) of 75% and, in some cases, even 100%, up to a limit of R6 937.

Product offering

GEMS offers six excellent healthcare benefit options, namely Tanzanite One, Beryl, Ruby, Emerald Value, Emerald and Onyx. Our goal is to help public service employees and their families to get the best possible healthcare at the most affordable rate. 

Tanzanite One and Emerald Value are entry-level options where cover is provided by designated provider networks.

• Tanzanite One is an Entry Level Care-coordinated Network Option which provides In-Hospital benefits within a defined hospital network subject to an annual hospital limit. Out-of-Hospital benefits   subject to GEMS Network and FP nomination and Specialist rules.

• Emerald Value is a High Level Care-coordinated Network Option which provides Comprehensive In-Hospital benefits within a defined hospital network. Comprehensive Out-of-Hospital benefits subject   to GEMS network, FP nomination. Day-to-day Block Benefit.

• Beryl is an Entry Level Network Option that provides In-Hospital benefits subject to an annual hospital limit. Out-of-Hospital benefits subject to GEMS network.

• Ruby is a Mid-Level Savings Option which offers members Comprehensive In-Hospital benefits. Out-of-Hospital benefits subject to a Savings account and Block Benefit. 

• Emerald is a High Level Benefit Option which provides Comprehensive In-Hospital benefits and Comprehensive Out-of-Hospital benefits subject to Day-to-day Block Benefit and Primary Care     Extender Benefit.

• Onyx is a Top Level Benefit Option which provides Comprehensive In-Hospital benefits and Comprehensive Out-of-Hospital benefits subject to a high value Day-to-day Block Benefit.