To protect members' benefits, GEMS is on a drive to provide a safer environment for processing claims. Certain processes have been put in place to help GEMS to better validate the submission and payment of claims.
One of the process changes is the termination of direct payments to certain healthcare providers due to restrictions placed against them by the Scheme. A list of healthcare providers on indirect payment is published monthly on the GEMS website (www.gems.gov.za). Since June 2013, these healthcare providers' claims were rejected.
Members are now responsible for submitting a claim for services provided by these healthcare providers directly to the Scheme. This means that if you visit any of these healthcare providers, you have to pay the costs for services from these healthcare providers directly to them and claim this amount back from the Scheme. Read more about the claims submission process further on in the Member refund process article.
Your support regarding this process is appreciated, as we continue in our fight to eradicate fraud and protect your benefits. If you have any queries in this regard, you are welcome to connect with us on 0860 00 4367 or [email protected].
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