2008 Member offering

Speech by the Prinicpal Officer of GEMS: Dr Eugene Watson >

Thursday, 1 November 2007, Cape Town

> 2008 Member offering and the Friends of GEMS programme

Honorable minister, Chairperson, colleagues and members of the media - good day to you all and thank you for taking the time to join GEMS in the sharing of some good news.  Dr Levin described 2007 as a remarkable year for GEMS. I am confident that 2008 will follow in this vain.

When considering which changes to make to the benefit structure of each of GEMS' five benefit options, we first considered ‘what has worked' and then we carefully considered the wishes, requests and needs of our members. During 2007 we established, along with other communication tools, a dedicated email address for members to make suggestions - encouraging member participation in not only the selection of benefits but also the various services on offer.  Guided by these suggestions, our policy objectives and the need to ensure GEMS remains sustainable, we have developed enhanced benefits for 2008.

Benefit changes
In 2006 we had a good package.  With member's guidance the 2007 package got better. Now, for 2008, I'm pleased to announce that we have expanded the benefit structure even further.

Sapphire and Beryl (network options managed through the Prime Cure network)
o All in and out-of-hospital benefit limits have been increased by 5%

Ruby (Personal Medical Savings Account, service provider of choice)
o All in and out-of-hospital benefit limits have been increased by 5%
o A day-to-day block benefit with an annual limit of R1 000 per family has been introduced.  If a family's Personal Medical Savings Account (PMSA) is exhausted, then the family will enjoy an additional R1 000 from Scheme benefits for day-to-day medical expenses.  This new benefit does not have a sub-limit per beneficiary
o Separate benefit limits for organ transplants and dialysis have been introduced.  The two groups of conditions were previously combined into one benefit but members now have access to greater benefits for either of the two limits.  The new annual benefit limits are as follows:
- Organ Transplants: R350 000 per family
- Dialysis: R150 000 per family
o The oncology benefit has increased to R189 000
o Four new conditions, over and above the 26 conditions covered as part of Prescribed Minimum Benefits, have been added to the list of Chronic Diseases covered
o A home birth benefit of R6 000 per beneficiary has been introduced

Emerald (Traditional option, service provider of choice)
o All in and out-of-hospital benefit limits have been increased by 5%
o Basic dentistry has been removed from the Block Benefit and a separate basic dentistry benefit of R1 000 has been introduced within the overall dental benefit
o By removing basic dentistry for the Block Benefit members now have more for GPs and Specialists
o The Allied Health Workers benefit has been increased by 60% to a family limit of R800
o Separate benefit limits for organ transplants and dialysis have been introduced. The two groups of conditions were previously combined into one benefit but members now have access to greater benefits for either of the two limits. The new annual benefit limits are as follows:
- Organ Transplants: R350 000 per family
- Dialysis: R150 000 per family
o The oncology benefit has increased to R210 000
o Four new conditions, over and above the 26 conditions covered as part of Prescribed Minimum Benefits, have been added to the list of Chronic Diseases covered
o A home birth benefit of R6 000 per beneficiary has been introduced

Onyx (Traditional option, service provider of choice)
o All in and out-of-hospital benefit limits have been increases by 5%
o A benefit of R2 000 for out-of-hospital contraceptives, including intra uterine contraceptive devices, has been introduced
o The GP benefit has been included in the Block Benefit giving members greater access to GP care
o Separate benefit limits for organ transplants and dialysis have been introduced as follows:
- Organ Transplants: R350 000 per family
- Dialysis: R150 000 per family
o The oncology benefit has increased to R275 625
o Four new conditions, over and above the 26 conditions covered as part of Prescribed Minimum Benefits, have been added to the list of Chronic Diseases covered
o A home birth benefit of R6 000 per beneficiary has been introduced

Contribution increases
Based on the significant enhancements made, the contribution increases for 2008 vary between only R12 and R224 depending on the benefit option the member belongs to.  The average contribution increase for a family of three is 11.4%. This increase, off a low base, is in line with industry averages and below that of many medical schemes.

Importantly, appreciating the significant benefit enhancements, it is clear that GEMS continues to offer members true value for money.

Friends of GEMS
The benefit changes and contribution increases are not the only example of our member responsiveness.  GEMS will be launching the Friends of GEMS programme to its members in January next year.

The Friends of GEMS programme is an accessible, convenient and easy to use provider registry that allows members' access to the contact details of healthcare providers willing to see GEMS members at the Scheme rate without any additional surcharges.  By simply sending an SMS, members can receive up-to-date contact details of at least three Friends of GEMS in their area in the medical discipline or service they require.

Providers have been invited to participate since October and we currently have almost 500 service providers registered on the programme, who all stand to benefit tremendously from this initiative.

Our commitment to all GEMS members for 2008 is to continue striving for service excellence.  We believe that the additional benefits, as well as the Friends of GEMS programme, will further enhance this commitment and assist us in achieving our policy objective.

Thank you