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Risk Management
Risk Management
Left to right: Mr Charles Dambuza, Ms Damaria Pholosi,
Mr David Makgalo, Ms Nokukhanya Zwane
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Links to Related Websites
› Council for Medical Schemes
› Health Professional Council of South Africa
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Claims...
› Where do I send my claims?
› What is the correct process to submit my claims?
› When will a claim be paid to the service provider?
› How do I submit a claim I've already settled?
› What should I do with my mailed claims statement?
› What is the cut-off date for submitting claims?
› Where do Healthcare Providers submit their claims?
› What details must I provide when submitting claims?
› Within what period of time must my claim reach GEMS?
Chronic Medicine...
› What is chronic medicine?
› How do I apply for authorisation of my chronic medicine?
› How do I obtain my approved chronic medicine?
› What if chronic medicine authorisation request has been declined?
› Can I appeal a medicine authorisation?
› What if my authorised benefit changes?
› How do I apply for emergency supply of medicine?
› How do I apply for advance supply of medicine?
FAQs...
› Who qualifies as a dependant?
› Can I include my extended family members as dependants?
› Can contract workers join GEMS?
› If a member dies, are dependants still covered?
› Why am I suspended?
› What role does my employer play in my relationship with GEMS?
› How do I know which benefit option to select?
› If I join GEMS during the course of the year, how will my benefits be allocated?
› How does GEMS function?
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