Bigger and better benefits

1 November 2007

In Cape Town today the Government Employees Medical Scheme (GEMS) announced a substantially enhanced benefit structure and an innovative new provider registry designed to bring providers and members closer together.  "Friends of GEMS", as it is known, will make it easy for members to find healthcare service providers through SMS technology. The scheme also announced its contribution increases for 2008.

Amongst the 2008 GEMS benefit enhancements is a 5% increase in limits for all in- and out-of-hospital benefits across each of the five benefit options of the scheme.  GEMS also introduced a day-to-day block benefit with an annual limit of R 1 000 per family providing an additional R1 000 for day-to-day expenses.

For the first time separate benefits for organ transplants and dialysis were added to the benefit line-up. Other highlights included a substantially enhanced oncology benefit and the inclusion of a further four additional chronic conditions added to the list of 26 Prescribed Minimum Benefits. On the Emerald option a new basic R1 000 dentistry benefit, over and above the Block Benefit, has been added to provide more coverage for GP and specialist visits.  On the Onyx option a R2 000 out-of-hospital contraception benefit including intra uterine contraceptive devices has been added.

Dr Eugene Watson, Principal Officer of GEMS, said that in line with requests from members the scheme has made its ‘biggest and best' benefit enhancements to date.  "During 2007 we set up, along with other communication tools, an email address dedicated to encourage member participation in the selection of benefits. When considering the 2008 benefit structure we took careful note of the wishes and needs of our members by using this communication channel."

Dr Watson announced an average contribution increase of 11, 4%.  Depending on the chosen option the nominal rand value varies between R12 and R220 per month.

Ms Geraldine Fraser-Moleketi, Minister of Public Service and Administration, lauded GEMS saying that the successful implementation of GEMS was an example of the ‘business unusual' public service required by the country and its people. She added that GEMS is making a number of significant contributions to public sector initiatives:

It is enhancing the productivity and well being of public service employees through the provision of healthcare benefits and disease management programmes which link to the Employee Health and Wellness programmes implemented throughout the public service;
It is promoting broad-based Black Economic Empowerment by using procurement processes that have selected leading suppliers on criteria that include their empowerment credentials; and
Through contracts with the provincial departments of health it is generating revenue streams for the public sector when its members are admitted to public facilities and also reducing the burden on these facilities by extending scheme cover to those employees who previously did not have any.
"The mandate of GEMS is to provide public service employees with healthcare cover that is efficient, cost-effective and equitable while affording additional choice to those that wish to purchase more extensive cover," said the Minister.  "Access, equity, affordability and differentiation - these are the same principles spoken to in our Constitution and permeating through all the many programmes implemented across all three spheres of local, provincial and national government."
She added that the new medical assistance policy introduced by Government in 2006 and adjusted in 2007 has ensured that all employees are provided with greater access to GEMS.  "Employees' income levels and family size are not deterrents to them accessing this key employee benefit.  Thus far, 53% of employees enrolled on GEMS did not previously make use of the medical scheme subsidy."  

"If we look further at equity; 62% of GEMS members are females.  Appreciating how women have been systematically marginalised and disadvantaged, it is good to know that we are enabling our female employees to access this useful benefit.  Further, the average size of GEMS families is larger than that of the industry indicating and confirming the equitable nature of our interventions," said Minister Fraser-Moleketi.

Dr Richard Levin, Chairperson of GEMS, listed a number of achievements the scheme has notched up during the year.  Amongst these is becoming the largest restricted medical scheme and the third largest in the country, with approximately 190 000 principal members.  "Since the end of last year GEMS has grown in membership by a phenomenal 400%.  At present the scheme provides healthcare cover to more than half a million South Africans," said Dr Levin.

Other achievements mentioned were GEMS' first unqualified audit conducted during the year, its sustained ability to pay claims against the backdrop of rapid membership growth, the election of half of the Board of Trustees from member nominees and the scheme's low complaints ratio.

The "Friends of GEMS" programme, announced by Dr Watson, entails medical service providers such as GP's, dentists, physiotherapists, psychologists and many more that are willing to see GEMS members at agreed rates without any additional surcharges.  There are 23 000 providers countrywide already registered as "Friends of GEMS".

Dr Watson explained that GEMS members will be able to send an SMS to a specified number, simply stating ‘GP' or ‘dentist' or any other medical service they need, after which up to date contact information of at least three such providers within their area will be sent to them.

"The ‘Friends of GEMS' programme is an accessible, convenient and easy to use provider registry and just one more way in which we continue to strive for service excellence," said Dr Watson.  "It will be introduced fully to members in January next year."

Minister Fraser-Moleketi concluded by stating that GEMS is an excellent example of how Government delivers on its promises to its employees.
 
Government is pleased with the scheme's achievements in such a short space of time and we hope that the lessons learned with this scheme can be duplicated by other employers as well.  The positive impact GEMS is having on the entire medical scheme industry is setting an example to all employers in all sectors of our economy."