Surge in membership

The Government Employees Medical Scheme (GEMS) today announced its benefit structures for 2007. The scheme, with its membership restricted to public servants only, also announced that it has reached a membership level of 45 000 principal members. This represents approximately 120 000 covered lives.

"The fact that 40% of GEMS' members did not previously access the employer subsidy and had no medical scheme cover, means that the scheme is making significant progress towards correcting the imbalances of the past and promoting equitable access to the employer subsidy," said Minister for Public Service and Administration, Geraldine Fraser-Moleketi, at a press briefing in Parliament today.

According to Dr Eugene Watson, Principal Officer and chief executive of GEMS, this membership level was achieved in a matter of mere months as the medical scheme was only launched in January this year. "Since mid-year we have been registering new members at a rate of 650 per day," he said. "We expect to reach the 60 000 membership mark by year-end."

Minister Fraser-Moleketi said that an additional advantage of the growth in membership is that the synergies between Gems and the public health System will now become reality. "All five of the healthcare plans on GEMS make use of private healthcare facilities for primary care. For tertiary care, four of the five plans make use of private facilities - only the Sapphire option uses public sector hospitals. As membership increases we will see new revenue streams flowing through the public sector at the same time as we experience a relative reduction in the patient load in the public healthcare system," she said.

The Minister also felt that the growth in membership will help the scheme to further negotiate with service providers. "The more its membership grows, the more buying and bargaining power it will have to continue sustaining the ideals it upholds, especially those of offering employees value for money."

Dr Richard Levin, Director-General of Public Service and Administration and GEMS' chairperson, said that the scheme has exceptionally sound contracts with healthcare service providers in place, all of which are based on and include performance measurements. "GEMS does not own, or have any stake in, its providers, which allows for excellent objectivity and control when assessing our providers performance."

Good news for all GEMS members was the announcement of the scheme's contribution increases for 2007. On average, GEMS members will be paying 7,3% more for their healthcare coverage from next year onwards. This compares favourably with an industry average increase ranging from 9% to 15%, well above CPI.

"In actual rand amounts, the 2007 price increases ranges from R1 to R109 per month," Dr Watson explained. "Importantly, GEMS members can look forward to enhanced benefits on every scheme option."

The changes on Sapphire include a new optical benefit and a contraceptive benefit, while all other benefit limits increased by 5%. In addition, members on this option can select to access private hospitals under specific circumstances. Beryl has been improved to include the contraceptive benefit and also offers an overall benefit increase of 5%.

The Ruby option now offers a revised advanced radiology (e.g. MRI, CTI scans) limit as well as the overall benefit limit increase of 5%. At the request of members, significant changes have been made to the Emerald option. It will offer an enhanced GP and dentistry benefit, as well as a larger advanced radiology benefit and a separate limit for pathology and basic radiology. The Onyx option sees benefit limits enhanced by 5%.

Dr Watson also announced that, from 1 January 2007, GEMS will introduce a Designated Service Provider (DSP) for the provision of chronic medication to Ruby, Emerald and Onyx members registered on the Chronic Medicine Programme. "Members will now have their chronic medicine delivered to their homes at no additional charge."

According to Minister Fraser-Moleketi, the positive response and letters of compliment that GEMS has received this past year proved that the scheme's service levels were outstanding. "It is evident that GEMS members don't limit their appreciation to the fact that the scheme pays their medical bills on time. They appreciate GEMS because of the exceptional service and the personal touch bestowed on them."

Dr Levin said that Government was adamant to have GEMS succeed and do so in an exemplary manner. "GEMS is here to stay, and it has the backing, structures and people in place to make it one of the best-governed medical schemes in South Africa today," he said.