Govt's medical scheme spends almost R1bn to enhance benefits, including private hospital access

The Government Employees Medical Scheme has reinvested close to R1bn to enhance benefits for members for 2020, it said in a statement on Thursday.

GEMS, the country's largest restricted medical Scheme, has over 720 000 principal members and over 1.8 million beneficiaries, according to its CEO Dr Stan Moloabi.  


Parliament recently heard that in 2017 GEMS had a market share of 46%. The scheme has now announced a weighted average contribution increase of 7.69% across all its benefit options.

According to GEMS, this is the second year in a row, that it has kept its contribution increase one of the lowest in the industry.

Earlier this week, the Institute of Risk Management South Africa for the second year in a row awarded GEMS for outstanding risk management in the healthcare sector. The Scheme was recognised for its leading Claims Management Forum.

GEMS has developed a comprehensive risk management plan that has enabled the Scheme to reach the 25% statutory reserve requirement while improving the financial stability of the scheme in less than three years.

Access to private hospitals 

Another change announced by GEMS, is that the scheme's Sapphire option - which has been renamed Tanzanite - now offers enhanced benefits. The Tanzanite One option, for example, will from 2020 offer members access to private hospitals as long as they use the GEMS private hospital network.

Members on Tanzanite One will be able to nominate a general practitioner of their choice - from GEMS-approved network - to "coordinate" their health care needs.

Public service employees on employment levels one to five may qualify for a 100% subsidy for the enhanced Tanzanite One benefit option, according to Moloabi.

Members on the Emerald Value Option will have the lowest monthly contributions increase of all the available GEMS options.

GEMS members who want to change to a different benefit option of the scheme, have until December 7, 2019 to do so.
 
The union Solidarity said in a statement on Friday that it condemns what it deems to be "the hypocrisy" of the decision by GEMS to provide access to private hospitals for members belonging to its cheapest option.
 
"While Solidarity welcomes the decision itself and believes that all South Africans should have access to private medical care, they shed light on the state’s incoherent behaviour which, on the one hand, regards National Health Insurance (NHI) as a highly necessary intervention, but then negotiate access to private services for their own officials," said Solidarity.


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