GEMS, the best value proposition for Government employees

Efficient, cost-effective and equitable access to healthcare
 
Dr Guni Goolab, Principal Officer of the Government Employees Medical Scheme (GEMS) says the Scheme continued to fulfil its mandate to provide Government employees with efficient, cost-effective and equitable access to healthcare.

"In the past decade GEMS has become integral part of the South African healthcare funding landscape. It is the only medical scheme in the country that has made an impact on and inroads into the previously uninsured market and we continue to strive towards providing affordable healthcare cover for public service employees in South Africa," he added.

Through the years the Scheme has often been lauded for the positive impact it is having on the medical schemes industry where it continues to set an example to employers in all sectors of the economy where there is still a need to redress past imbalances. This has been achieved through focused practice, dedication and innovation.

Dr Goolab noted that GEMS continued to be the very best medical scheme option for Government employees. He highlighted a range of pertinent facts to illustrate the unique positioning of the Scheme:  

• When compared to other medical schemes, the GEMS benefit plans, namely Onyx, Ruby, Emerald, Beryl and Sapphire, are on average 19% less expensive, with similar or increased benefits.
• At 7.4% the non-healthcare expenditure of GEMS, which includes administration costs, is substantially lower than the industry average of 11.8%. This careful management of the Scheme has resulted in savings of R1.2 billion. The funds saved by the scheme has allowed us to fund more healthcare services to you.
• GEMS is now responsible for 666,755 principal members and approximately 1.8 million beneficiaries.
• 54.5% of all eligible public service employees are enrolled on the Scheme.
• GEMS remains the largest contributor to the overall growth of the medical scheme sector and represented 20.3% of the sector by the end of 2014.
• 90% of members are within 10km of one of our 12 500 healthcare providers.
• The average age of GEMS beneficiaries is 31.2.
• The percentage of pensioners covered by the Scheme is 13.5%.

Contribution rate increases and benefits for 2016

Commenting on the scheme benefits and contribution rate increases for 2016, Dr Goolab said GEMS would be implementing an average weighted contribution increase of 9.39% during 2016, which is lower than that of 2015.

"Ideally, we would have wanted to reflect an even lower increase to accommodate members but for now this was unfortunately not possible. Members can however take comfort in the knowledge that the GEMS increase is at the lower end of the medical schemes industry, is seeing increases of as high as 10,9% for the coming year," he said.

The contribution rate increases on the GEMS options are as follows:

• Sapphire - 8.90%
• Beryl - 8.90%
• Ruby - 9.25%
• Emerald - 9.25%
• Onyx - 11.15%

Understanding member needs
"As a Scheme that covers 1.8 million lives, more than 300 000 of which are currently enrolled on disease management programmes, GEMS is taking an increasingly proactive route in dealing with diseases of lifestyle," said Dr Goolab.

"GEMS is re-aligning its products, services and benefits to emphasise preventative over curative interventions to reduce the risks to its members. An aggressive drive to promote preventative benefits including screening tests and a workplace exercise and lifestyle programme, is therefore in the process of being rolled out."

One such intervention is the GEMS Workplace Exercise Programme, which is specifically designed around the needs of public service employees which is being phased in over several years. The programme, which was introduced in October 2015, aims to help public servants to become healthier and more active and is to be implemented within all interested government department, nationwide," added Dr Goolab.

The Scheme will be introducing an array of new benefits along with a number of industry leading annual preventative care and screening test benefits to members. These include:

• Mammograms (breast cancer screening)
• Bone density scans (to screen for osteoporosis)
• Pap smears (a screening test for cervical cancer)
• PSA tests (blood tests that can detect the early signs of an prostate cancer)
• Occult blood screening (a test to check stool samples for blood which may indicate colon cancer or polyps in the colon or rectum)
• Glaucoma screening (an eye exam to detect glaucoma)
• Influenza vaccines
• Pneumococcal vaccinations