Ruby

The Ruby option offers comprehensive in- and out-of-hospital benefits through a Personal Medical Savings Account (PMSA), hospital plan and a Block Benefit.

Important things to remember about the Ruby option

• The Ruby option includes a PMSA, hospital plan and a Block Benefit. The PMSA consists of 20% of your contribution allocated to a savings account held in your name. This account pays for your out-of-hospital or day-to-day medical expenses. Once the PMSA limit is reached, the out-of-hospital claims will then be paid from the limited Block Benefit. You will receive an annual PMSA statement that will show you all transactions and entries made on your savings account. This statement will be distributed at the time IT3(b) statements and tax certificates are issued.
• There is a specific Ruby, Emerald and Onyx (REO) Network that is made up of General Practitioners (GPs) specialists and pharmacies who have agreed to charge the Scheme Rate and follow the managed care rules applicable to the GEMS Network relevant for these options. Click here to find a GEMS Network doctor in your area or call the GEMS Call Centre on 0860 00 4367.
• You are encouraged to nominate a GP on the GEMS REO GP network, who you will consult for all your doctor visits. However, penalties will not apply if you do not nominate an GP.
• Your nominated GP needs to refer you to a specialist. Remember to ask for a specialist on the GEMS Specialist Network (only applicable to the Paediatricians, Obstetricians and Gynaecologists). Network GPs and specialists have agreed to bill a contracted rate so that you will not have to pay any out-of-pocket expenses for your consultations. 
• You need to get pre-authorisation for all hospital visits, out-patient visits to a hospital, MRI scans, CT scans or radio-isotope studies, in-hospital physiotherapy, ambulance transportation and specialised dentistry.

Changes to Ruby Personal Medical Savings Account (PMSA)

In 2017, a Constitutional Court ruled that the Personal Medical Savings Accounts (PMSA) form part of the assets of medical schemes. Although members still have control over their PMSA, which they can use to cover out-of-hospital and day-to-day healthcare needs, they will no longer earn interest on their PMSA. This is effective 1 January 2018. Read more>

For more information, please visit the Council for Medical Scheme's website on www.medicalschemes.com and read CMS Circular 56 of 2017. 

Your 2018 benefits

View your 2018 benefit schedule

Disease Management Programmes

• Out-of-hospital benefits
• Chronic medicine programme
• HIV/AIDS management
• Oncology management
• Optometry management
• Dental management
• Maternity Programme
• Hospital management

What medicine does GEMS pay for (Formulary)?

• Restrictive Formulary
• You can also visit the Formulary Check service to conduct a search.

What does GEMS not pay for?

Click here to see what GEMS does not pay for.

Forms

• Application Form
• Chronic Medicine Application form
• HIV Disease Management Form

Cost of membership for 2018

Contributions (how much you pay each month to be a member of GEMS)

As always, GEMS aims to bring you the best possible healthcare benefits to suit your needs. Offering you more choices is what our commitment to you is about.

The contributions in the table below do not include employer subsidies. In some cases, you might qualify for a subsidy from your employer. A subsidy is an amount your employer pays towards the cost of being covered by GEMS. If you qualify for a subsidy, the employer will pay a portion of the contribution each month and you will pay the rest. You must find out about the subsidy from your employer.

If you have any questions about your subsidy, you should discuss them with your Human Resources (HR) Department. A useful contribution calculator will help you to work out your monthly contributions, if you are employed in the public service.

Please note: 20% of Ruby contributions go towards the Personal Medical Savings Account (PMSA)

Salary Band	Member	Adult	Child
R0 - R12 760	R2 230	R1 635	R860
R12 760.01 - R22 037	R2 485	R1 825	R965
R22 037.01 +	R2 760	R2 025	R1 065

Note:

Salary column: This reflects the monthly salary amount before tax or other benefits are deducted.

Member column: This column shows how much the principal member, who is the public service employee registered with GEMS, has to pay.

Adult column: This oclumn shows how much you have to pay for your adult dependants.

Child column: This column shows how much you have to pay for a child dependant. GEMS covers children up to the age of 21, unless the child is mentally or physically disabled or is below 28 years of age and is a student registered at a recognised educational instutution.

Contribution statements

We send a contribution statement to members who owe money to GEMS on a monthly basis. We also send a contribution statement to all members on a quarterly basis. The contribution statement sets out your monthly contribution payment and any money that you owe to GEMS. This statement helps you to check that your contributions are always up-to-date.

Managing arrear contributions

You might be behind in your payment to GEMS if any of the following happen:

• Your employer has not deducted your monthly contribution costs from your salary. This may happen to new members when the membership start date is captured after the date of the monthly deductions for that particular month. This might also happen if you move between departments.
• Your salary increase was backdated and this increase moved you into a higher contribution category.
• You added a dependant, but the additional contribution for this new dependant was not taken into account on time for the next contribution payment.
• Your contract ended and your new contract was not active in time for the next payment.

GEMS will send you a letter confirming the amount that you owe us. You will also receive a monthly contribution statement if your payments are behind.

If you need help with paying the contributions you owe, please contact the Scheme or ask your HR Department to help you with the repayment terms.

Remember: Your annual contribution increases are effected in January and may be increased with your annual salary increase. It is your responsibility to ensure that your contributions are paid monthly and are up to date.