GEMS Hospital Plan
July 18, 2016
The exorbitant premiums of medical aids accompanied by shrinking services have created a pressing need for more affordable hospital plans in South Africa. Many government workers are signing up for a GEMS hospital plan to help them financially.
When evaluating hospital cover in South Africa, you need to look at the different organisations behind them.
Some of the best South African hospital cover comes from providers such as Fedhealth, Momentum Health, Bonitas, Discovery Health, GEMS and others.
Before you consider the benefits and monthly premium costs of these hospital plans in South Africa, you should know that plans offered by insurance companies will offer much lower benefits than those the medical schemes offer. They are also not obligated to pay the minimum requirements as set out under the Medical Schemes Act.
GEMS Hospital Plan – Access to Affordable Health Care
Government Employees Medical Scheme, better known as GEMS, started in January 2005. This system is a Government employees scheme – a restricted scheme – designed to satisfy their health care needs. Their aim is to provide all employees in the public service with access to affordable health care benefits.
Five Different Products
- Ruby, Sapphire, Beryl, Emerald and Onyx. These plans each offer their range of benefits at different price ranges. GEMS medical aid reckons that they are considerably cheaper – in fact between 10% and 25% cheaper – than other medical aid schemes. The Beryl plan will provide in-hospital care at public or private facilities. Members must access medical care only from designated providers.
- The Beryl and Sapphire plans are the entry level choices from GEMS medical aid. Sapphire is inexpensive, providing out-of-hospital care at private facilities and in-hospital cover at public facilities.
- Emerald is the traditional option and is similar to most other medical scheme plans.
- Onyx is their top of the line option, a comprehensive plan.
- Ruby offers members a savings account for day-to-day medical expenses as well as a GEMS hospital plan. The Ruby option does provide comprehensive in- and out-of-hospital benefits through what is known as a Personal Medical Savings Account (PMSA), hospital plan and a Block Benefit.
More About the PMSA
The PMSA comprises 25% of your contribution and goes to your savings account. This feature pays for out-of-hospital or day-to-day medical expenses. Once you reach the limit, the out-of-hospital claims the limited Block Benefit pays the benefits.
Every year you’ll get a PMSA statement that will show all the transactions you made on your savings account, plus any interest earned. There is also an Onyx, Emerald and Ruby Network, which is made up of family practitioners and pharmacies. For instance, they charge the Scheme rate and also follow the managed dare rules according to the GEMS Network.
You’ve Got the Support of a Big-Name Medical Scheme
When looking at hospital plans, always assess your medical needs first. For instance, if you are healthy and don’t require day-to-day care, a hospital plan like Ruby from GEMS might well be enough. They’ve got benefits when you join them.
You’ll receive a fitness welcome pack and access to the GEMS contact centre. GEMS will send you different brochures with useful health related information. So that showsGEMS are serious about supporting you, no matter what plan you choose.
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All info was correct at time of publishing