How can a member incur co-payments?

Johnny, Mrs Jones's son wakes up with a sore throat and an ear infection. Mrs Jones calls her network Family Practitioner (FP), but unfortunately theres no availability for an appointment as her FP is fully booked. Mrs Jones then decides to take Johnny to Dr Dladla, as his surgery is only two doors away from her house. Dr Dladla is not registered on the GEMS Network however he was able to see Johnny. Dr Dladla treats Johnny and gives him a prescription for his medicine. Mrs Jones hurries to Sunny Pharmacy, just a road away to collect Johnny's medicine. Two weeks later Mrs Jones receives her claims statement in the post and reads that she is faced with three co-payments during one doctor's visit. How is this possible?

Firstly, let us understand what a co-payment is?
Co-payments are portions of the cost of procedures or services provided by doctors for which members will be responsible to pay. The co-payment can be a certain amount, or a percentage of the total bill.

How can co-payments be avoided?

• Only visit doctors on the GEMS Network
• Use GEMS Network pharmacies
• Use generic medicine or medicine that is part of the GEMS Formulary (the list of approved medicine, tests or services)

For more information on co-payments call 0860 00 4367, email [email protected] or visit the GEMS website on www.gems.gov.za.