Why do member contributions increase annually?

Contributions increase annually in order to cover annual inflation and
increasing claim costs. Claims increase due to:

• medical inflation and increase in provider fees
• broader access to healthcare
• members becoming older and needing more healthcare.

To compensate for this, the Scheme is continuously thinking of ways and
implementing interventions to ensure GEMS stays affordable. The following
are a few ways how GEMS is ensuring affordability:

• Networks: Network of providers contracted to provide services to GEMS members at lower rates.
• Medicine management: The Medicine Exclusion List (MEL) and Medicine Price List (MPL) ensure that medicine is managed correctly which prevents the Scheme from paying for medicine that is costly and has not yet proven to be effective
• Disease management programmes: Members who are on these programmes are monitored to ensure that they are taking their medicine and adhering to their treatment. This ensures that members with chronic diseases are well taken care of, which will decrease hospital admission costs.
• Care coordination: Coordination helps to ensure that healthcare professionals work together and feel encouraged to share information amongst themselves. This in turn prevents duplicating diagnostic tests and shows progress in overall health results, such as improvement in quality of care and a reduction in hospital admissions and re-admissions.