In December 2007, Lebo Montshiwa* noticed that a number of items that had never been dispensed to her by her local pharmacy had somehow found their way on to her GEMS claims statement. Lebo immediately contacted Lerato Segopo*, the owner of the local Pharmacy, to find out what happened. Segopo told Lebo that it was standard practice.
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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 your benefits, processes have been implemented to enable us to better validate the submission and payment of claims.
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Your chronic medicine prescription is, by law (Medicines and Related Substances Control Act), valid for a period of six months. A prescription is also only valid for the duration stated on the prescription. Before your current prescription expires, ensure that you obtain a valid repeat prescription from your doctor.
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Did you know that you can access your membership and benefit information online? The GEMS Member Online functionality on our website (www.gems.gov.za) allows you to access and manage your GEMS membership information online..
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The Sapphire and Beryl options offer unlimited annual Network GP visits, subject to Scheme Rules and pre-authorisation. While you are free to visit your Network GP as often as is medically needed, once you have used five appointments, all visits thereafter are subject to pre-authorisation.
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You needed GEMS to be more visible and we have listened! Member helpdesk and marketing services have been introduced to provide more comprehensive services to members and those intending to join GEMS.
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Optical benefits are subject to applicable limits and sub-limits. These limits are the maximum amount that is available for optical benefits.
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It's important that you know and understand your dental benefits and how to access them. In this article, we highlight the dental benefits for each GEMS option.
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The Practice Code Numbering System (PCNS) is a list of unique practice billing codes for providers of healthcare services in South Africa.
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