More about the Emerald Value option
You must nominate a General Practitioner, who must be on the GEMS Network, as your first-line when seeking medical care and who you will consult for all your doctor visits.
A 30% co-payment will apply to all GP claims received from a non-nominated GP.
You must use a hospital from the Emerald Value Hospital Network for your in-hospital needs.
View the GEMS Network Hospital list here.
If you use a non-network hospital (i.e. not included in the network hospitals on Emerald Value Option) then a co-payment of up to R12 000 will be payable.
This co-payment will be waived in the case of a medical emergency, but once patients have been stabilised, the Scheme may require that the patient be transferred to a network hospital.
Members and dependants are still required to obtain authorisation for admission to a network hospital.
Should you be admitted into a network facility and the authorization is not obtained as per the Scheme Rules, a late authorization penalty of R 1000 will be applied.
Specialist referral must be obtained from your nominated GP for all specialist requirements.
Provision is made in the event that you may require healthcare while travelling, or require specialised care that may not be available through your nominated healthcare providers, to ensure that your needs are taken care of.
As part of this, you are allocated three visits to a non-nominated GP per family per year for emergencies only, i.e. in cases where you cannot get to your nominated GP.
Please note: Access to this benefit is not automatic. You need to contact us by calling the call centre on 0860 00 4367 or sending an email to enquiries@gems.gov.za to ensure that you do not incur a 30% co-payment for such a visit.