The Eligibility Appeal ruling

The Government Employees Medical Scheme (GEMS) was established to provide equitable access to comprehensive benefits by public service employees, a specific class of employees of the State. It is noteworthy that GEMS' establishment was driven by the public service and always informed by public service policy on conditions of service. The Scheme has always welcomed enrolment by eligible employees, be they active or retired employees of the public service.

You may be aware that the scope of the Scheme's eligibility rules has been the subject of a legal process between the Scheme
and the Council for Medical Schemes since 2009, when GEMS was requested to revise its eligibility rules to permit a broader scope of employer and to remove any discretion applied by the Scheme with regard to which employers participate. The Scheme subsequently sought to obtain the Registrar's approval and registration of amended eligibility rules which would remove the Board's discretion pertaining to the approval of participating employers and which would clearly define the scope of the Scheme's eligibility rules in accordance with the Scheme's founding mandate, namely: to provide medical scheme cover for public service employees. The Registrar, however, sought to extend GEMS's eligibility rules beyond the public service (i.e. to include all organs of state) and the Scheme ultimately appealed the Registrar's decision. The Appeal Board, established under section 50 of the Medical Schemes Act, recently dismissed the Scheme's appeal on the basis that GEMS was established to cover any organ of state. The Board of Trustees is concerned with the outcomes of the ruling and has decided to conduct a review of the ruling.