GEMS medical aid was established in January 2005 in order to help Government employees to satisfy their healthcare needs. Prior to the founding of GEMS medical aid many government employees were not able to afford any type of medical cover. Those who did have cover found that it was becoming more and more expensive over time and they were not getting value for money. In addition, the government did not have much of an opportunity to participate in the management of the medical scheme which their employees are enrolled with.
GEMS medical aid have a very clear mission statement in that they aim to ‘provide all public service employees with equitable access to affordable and comprehensive healthcare benefits’. They have very strong values including simplicity, flexibility, integrity, value for money and clear communication with members.
With 5 different products, GEMS medical aid has a plan to suit everybody. The plans are named after gemstones : Sapphire, Beryl, Ruby, Emerald and Onyx. The plans offer a range of benefits at different price ranges. In fact, GEMS medical aid claim that when compared to similar plans from other providers that they will come out between 10% and 25% cheaper. The Sapphire plan in particular is designed to be as affordable as possible by providing out of hospital care at private treatment centres and in-hospital care at designated public facilities. Meanwhile the Beryl plan will provide in-hospital care at public or private facilities.
The Beryl and Sapphire plans are the entry level choices offered to GEMS medical aid. Members who are subscribed to these plans are required to access medical care only from designated providers. There area number of service providers who are contracted to GEMS medical aid to provide a number of different services including:
- Access Health – Maternity Programme;
- Europ Assistance – Emergency Medical Evacuation Dispatch (EMED) contact centre;
- Medipost Pharmacy – Chronic Medicine Courier Pharmacy;
- Medscheme – Contributions and debt management services; Correspondence services;
- Medscheme Health Risk Solutions (MHRS) – Managed care services;
- Metropolitan Health – Membership and claims services;
- Metropolitan Health Risk management – Clearing house services;
- Opticlear – Optometry managed care services;
- Pinnacle Health Solutions – Marketing and tele-marketing services;
- Prime Cure – HIV/AIDS disease management services, Dental management services; and
- Universal Healthcare Services – Chronic medicine management services; Strategic managed care services.
For the most comprehensive cover, members can opt for the top level Onyx plan from GEMS medical aid.
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