Stricter controls to protect our members and remain a sustainable medical scheme
Since our launch in 2006, we have prided ourselves on being able to provide all public service employees with equitable access to affordable and comprehensive healthcare benefits. To ensure that our members and their families have access to the healthcare they need, we undertook to:
While these measures were introduced to assist members to provide healthcare cover to their families, through the years we have noticed an increasing number of members have taken advantage of these measures through anti-selective behaviour.
What is anti-selective behaviour?
This behaviour affects not only the sustainability of the Scheme, but also directly affects your pocket. Members who behave in
this way access funds at the expense of other members who have contributed over a much longer period. This reduces the funds we keep in reserve for future healthcare needs of members and affects the rest of the membership as they have to pay higher contributions in subsequent years to replace the lost funds.
To protect the Scheme and you, our members, the Board has decided to apply some controls (also known as underwriting). These controls are in the form of waiting periods and will be applied as follows with effect from 1 October 2016:
Type of waiting period
|Main members who resign from
the Scheme with their dependants
(without also resigning from the
Public Service) and then re-join the
Scheme at a later stage
|3-month general waiting period -
subject to Scheme rule provisions
|Dependants who are resigned from
the Scheme and who are then reregisteredby the main member at alater stage
|3-month general waiting period - inline with Scheme rules|
|Dependants who join GEMS on adifferent date from the main member(excluding newborn babies andnewly-adopted children)||
3-month general waiting period aswell as 12-month condition specificwaiting period - in line with Scheme rules
These are measures we are compelled to take to limit exposure to anti-selection, fraud, waste and abuse within the Scheme, and ultimately to protect your interests and the Scheme's sustainability.
We will be setting up Lekgotla roadshows across the Public Service to engage with members on the changes and how these will affect you. Mental disorders are high among people living with HIV/AIDS with major depressive disorder (MDD) occurring almost twice as often among this group than among the general population. Mental disorders may increase an individual's risk , of HIV infection through increased social vulnerability, altered risk behaviour, associated substance misuse and loss of control in sexual relationships.