White collar criminals use deceit, dishonesty and disguise to gain business or personal financial advantage. It is unfortunate that among our dedicated healthcare providers there are some who engage in fraudulent activities.
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To protect members' benefits, GEMS is on a drive to provide a safer environment for processing claims. Certain processes have been put in place to help GEMS to better validate the submission and payment of claims.
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When you have paid a healthcare provider for a service, you may claim a refund from GEMS. Whether we pay the claim, and how much we pay, will be determined by the Scheme Rules. We make refund payments to members electronically, so you need to make sure that we have your updated, correct banking details.
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GEMS dispenses medicine every 28 days according to your valid prescription. If you do not take your medicine as prescribed, you may end up with extra medicine. When this happens, it is commonly known as oversupply of medicine.
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If you are a user of chronic medicine, it is very important that your medicine treatment should never be interrupted. It is essential to make sure that your chronic medicine prescriptions are always up-to-date.
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Here are some useful questions and answers to help you understand the difference between split and balance billing:
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With the Emergency Medical Service (EMS), GEMS members have access to a dedicated medical emergency assistance helpline
24 hours a day. The emergency line number, 0800 44 4367, is displayed at the back of your membership card.
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As a member of GEMS you never have to struggle or worry about anything you don't understand; whether it's about your benefit usage, claims or anything related to your benefits and membership GEMS has 18 walk-in centres in South Africa and two of these walkin centres are in your province.
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GEMS members are issued with a membership card to present to healthcare providers as required.
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Download various forms relating to your membership in easy-to-use PDF format. Click Here >
0860 00 4367 (Call Centre) [email protected] More Contacts >