When you go to hospital, there may be certain items that are not covered by the Scheme.
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Before July 2010, healthcare providers made use of a reference price list in respect of what they charged for procedures and visits. This was referred to as the National Reference Price List and was issued by the Department of Health. The NRPL was discontinued in July 2010 after a court ruling was issued in respect of its validity. GEMS responded promptly by introducing the unique GEMS tariff.
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GEMS provides an easy service for receiving your chronic medication at your home, office or nearest post office.
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Medipost was appointed as the Scheme's chronic medicine desginated service provider (DSP).
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As from 2011 all physiotherapy services provided to GEMS patients in-hospital, needs to be pre-authorised.
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Medical scheme fraud is a growing problem in the South African healthcare system. Fraud negatively affects medical schemes, their employees and their members, leading to increased member contributions and financial losses.
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When a healthcare service provider is suspected of fraud, they may be placed on indirect payments, which mean that the Scheme will pay the member, who will in turn have to pay the provider or the member must pay the provider and then claim back from the Scheme.
'Friends of GEMS' is a database of healthcare providers who have agreed to charge GEMS members the Scheme rate. No surcharges will be charged when members access care from these providers.
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GEMS is fully committed to delivering excellent, accessible and comprehensive emergency medical services to our more than 1.5 million beneficiaries.
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