GEMS largest restricted scheme

In a mere 18 months the Government Employees Medical Scheme (GEMS) has become the country's largest restricted medical scheme. Dr Eugene Watson, Principal Officer of GEMS, announced today that the Scheme covers more than 150 000 principal members and approximately 400 000 lives and is the largest restricted medical scheme in South Africa.

"GEMS has grown from strength to strength in its first year of operation and even more so since the beginning of this year," says Watson. "Despite the challenges associated with establishing a new medical scheme in this complex and highly competitive industry, much has been accomplished."

Professor Richard Levin, Chairperson of the GEMS Board of Trustees, says it was essential and strategically imperative for the Scheme to grow its membership sufficiently so as to achieve the critical membership mass that would support the competitive pricing of GEMS and its five benefit options.

By the end of 2006 (its first year of operation) GEMS had received a total of 70 000 applications. In the first and second quarter of 2007 this number has basically trebled. Today, the Scheme looks after the health and wellbeing of over 400 000 people. Interestingly, membership in the Eastern Cape has shown a monthly growth of 25% since December last year and the Scheme now covers more than 20% of the employees in the Northern and Western Cape.

Watson says that while the rapid membership growth is one area in which the Scheme counts its success, this success has come with its own challenges. "The service levels agreed to between the Scheme and its contracted service providers were tested by the exponential membership growth and the accompanying utilisation of member services over the past 18 months. All service providers found it necessary to systematically increase their operational capacity to ensure adherence to the agreed service levels, which were however maintained throughout 2006 and thereafter."

"The exponential growth in membership, the non-application of waiting periods, the collection of contributions in arrears and the availability of full annual limits for many benefit categories has necessitated prudent financial management," explains Watson. "In spite of this the Scheme recorded underwriting profits in 2006 - an exceptional achievement considering it was the first year of operation."

"Another important focus area remains the delivery of excellent services to members, especially as GEMS seeks to establish its legacy and culture of excellence," says Prof Levin. "This culture of excellence is now firmly entrenched in the performance-related service levels stipulated in the various contracts entered into between GEMS and its service providers."

Watson agrees: "All efforts are and will continue to be directed towards the relentless pursuit of an excellent member experience. We are also placing a special emphasis on activities and communication directed towards reaching all public service employees, especially those on salary levels one to five. Employees in these salary bands will gain much through the GEMS experience."