There is an increasing number of fraud cases reported where it is apparent that some members work together with healthcare providers to defraud the Scheme. Did you know that it is estimated that about R13 billion in yearly contributions paid by South Africa's eight million medically insured people is possibly lost to fraud and wastage?
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In a recent press release published on 30 September it was highlighted that GEMS is a leader in healthcare funding and corporate governance, which is complemented by its operational infrastructure and culture of excellence.
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The Scheme receives and assesses all claims in accordance with the Scheme rules and payment is subject to available benefit limits.
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As a member of GEMS working abroad, we understand that you have unique requirements to access your healthcare benefits.
Here are some tips for managing your claims from abroad and ensuring that your benefits are protected from abuse.
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Did you know that all interest earned by the Scheme through members' Personal Medical Savings Account (PMSA) must now be held in a separate trust account on behalf of GEMS members. Read our examples for a better understanding of the implications of Circular 38 of 2011by the Council for Medical Schemes.
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