Maximum benefits exceeded

The Scheme receives and assesses all claims in accordance with the Scheme rules and payment is subject to available benefit limits.
When your benefit limit or sub-limit is exceeded, your claim might be partially or completely rejected as the maximum benefit allowed has been exceeded.
Check your claims statement regularly to ensure that you are aware of your benefit limits. Your claims statement provides you with a detailed breakdown of the available benefit limits.
Columns to note in your claims statement:

• Benefit- provides a breakdown of the benefit category from which the claim is paid.
• Used- reflects the amount utilised for a particular benefit category
• Available- reflects the amount that is still available for a particular benefit category. If you have reached your benefit limit for a benefit category, the "Available" column will reflect as "Exhausted".

We recommend that you confirm your available benefits by contacting the GEMS call centre on 0860 00 4367 or visiting www.gems.gov.za and logging into the "member online" section to avoid unnecessary claim rejections.