Faced with an increase in irregular claims being submitted to the Scheme, GEMS has embarked on a drive to provide a safer environment for processing claims. To protect members' benefits, processes have been implemented to enable us to better validate the submission and payment of claims.
One of these process changes is the termination of direct payments to certain healthcare service providers due to fraud sanctions placed against them by the Scheme. As of June 2013, these healthcare service providers' claims will be rejected and GEMS members will be responsible for submitting the claim for the services rendered from these providers directly to the Scheme. This means members will have to pay healthcare costs for services from this healthcare provider directly to them and claim back from the Scheme.
The claims submission must include corresponding details and valid proof of payment, signed by the principal member, in the form of:
Your support regarding this change in process is appreciated, as GEMS continues to protect members' benefits.
If you have any queries in this regard, you can call GEMS on 0860 00 4367 or send an email to [email protected].
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