Solid growth and a healthy membership profile to differentiate GEMS in 2012

The Government Employees Medical Scheme (GEMS) has declared its benefit enhancements and contribution increases for 2012. Commenting on the announcement Mr Zava Colbert Rikhotso, Chairperson of GEMS, noted that despite a harsh economic climate, 2011 has been a good year for GEMS and its members.

"The Scheme has this year surpassed the financial targets set for it by the Council for Medical Schemes," said Rikhotso. "However, in order to strengthen Scheme reserves in line with legal requirements and to protect member interests into the future, we have had to increase the contribution rates of the Scheme for 2012."

"With effect from 1 January 2012 the average weighted contribution rates on the Scheme will increase by 8.75%, which is close on 2% lower than that of 2011. In order to ensure that members are not negatively impacted by the GEMS contribution increase come January 2012, the Scheme has facilitated an increase in salary bands across the board."

GEMS has continued to grow at an unprecedented pace and by the end of September 2011 the Scheme had added more than 74 000 new members to its membership base in 2011. 

Rikhotso observed that rapid membership growth would continue to place a strain on the solvency of the medical scheme. However, a medical scheme with a growing membership is generally in a healthier position as a larger membership dilutes risk. 

GEMS continues to provide members with value for money benefits that are unmatched in the industry. The Scheme concentrates on providing outstanding core benefits without the frills which tend to make medical cover less accessible. When it comes to non-healthcare expenditure GEMS has managed to maintain these costs at 6.2% of contribution income, which is less than half of the industry average. It is also encouraging for members to know that their scheme allocates 93 cents of every healthcare rand spent to funding their healthcare needs.

Rikhotso said that GEMS was ranked first in the Medical Scheme category of the 2011 Ask Afrika Orange Index awards for customer service in October 2011. "This welcome news re-affirms that the Scheme is getting a great deal right when it comes to taking care of its members. For the Scheme, winning this prestigious award was the ‘cherry on the top' in a string of successes achieved during 2011."

While GEMS continues to grow rapidly service levels are not compromised and are constantly improved. The GEMS Network of service providers has grown in line with its membership and now consists of more than 12 000 healthcare providers spanning 35 disciplines. The network includes general practitioners, optometrists, dentists, physiotherapists, psychologists and a range of other service providers.

GEMS Trustee, Advocate Lindi Nkosi-Thomas, said that there was no reduction in any of the current GEMS benefits. "Importantly, GEMS members can look forward to enhanced benefits on every Scheme option. At the end of the day, it is really all about meeting members' needs with appropriate, well-designed benefits. In 2012 the Scheme has several attractive benefits in the offing."

"Amongst the 2012 GEMS benefit enhancements is a 5.9% increase in limits for all in and out-of-hospital benefits across each of the five Scheme options. GEMS will also be introducing an inclusive, out-of-hospital benefit totaling R1 012 for preventative circumcisions across all Scheme options in support of government's HIV/Aids prevention drive".

"Members and their beneficiaries who have had cataract surgery can look forward to additional optical services benefits for lenses and frames, which will be added as a Prescribed Minimum Benefit entitlement come 2012. Healthcare providers on the other hand will no doubt be pleased to learn that the professional fees of providers who are registered on the GEMS networks will be increased by 6.65%. Those who do not participate in the GEMS Networks will receive a 5.9% increase," added Advocate Nkosi-Thomas. 

Rikhotso assured the more than 1.6 million beneficiaries who have placed their trust in GEMS that the pursuit of excellence within the Scheme would, as always, continue unabated. "Comprehensive benefits are now being made available to more than 585 000 members and their loved ones" he noted.

The Scheme paid R12.5 billion in member claims in 2010 and so far well over R10 billion in 2011. GEMS has done all of this while remaining well within budget so that members of the Scheme are safe-guarded at all times.

"The Scheme's pricing is highly affordable and GEMS has always placed a strong emphasis on pursuing its mandate, which is "to provide all public service employees with equitable access to affordable and comprehensive healthcare benefits. This will not change."

Nkosi-Thomas concluded that while GEMS may well be a large medical scheme in terms of its member numbers, the Scheme had managed to keep its services highly efficient and personal. "We offer ‘big scheme' security with ‘small scheme' service levels; and every one of our members is important to us. We believe that this is what gives GEMS the edge."