How to submit claims for member refunds

As a GEMS member, when you pay for services received from a healthcare service provider, you can claim the amount you paid from the Scheme, based on your available benefits, the applicable Scheme Rules and the Scheme Tariff. 

Tips for a quick and hassle-free claims process:

• Check that the service provider has included the payment on your account with the credit balance and that the account has been stamped.
• Ask the service provider for a dated receipt that shows the practice details. Sign the receipt before submitting it to GEMS for a refund.
• Make sure that GEMS has your latest contact information, such as your contact numbers (especially cell phone), email and postal addresses as well as your banking details.

If your service provider is willing to submit the claim on your behalf, remind the provider to do so within 120 days (four months) of the service date. This will ensure that your claim is not rejected as stale.