The Best Medical Aids
The Best Hospital Plans
Overall, GEMS offers 6 medical aid plans (Tanzanite One, Beryl, Ruby, Emerald Value, Emerald, and Onyx) starting from R1,363 per month. Additionally, GEMS offers 24/7 emergency support but does not offer comprehensive gap cover on any policy.
🔎 Medical Aid | 🥇 GEMS |
👥 Number of members | 1.8 million+ |
👤 Number of Employees | 500+ |
📈 GCR Rating | AA |
📉 Customer Rating | 3/5 |
📱 Mobile App | ✅ Yes |
⚕️ Chronic Illness Benefits | ✅ Yes |
🔎 Medical Aid | 🥇 GEMS |
📌 Date Established | 2005 |
📍 Headquartered | Cape Town, South Africa |
📈 Registration Number | 1959 |
📉 The average number of members | 1.8 million+ |
📊 Number of Markets | South Africa |
🔍 Number of Employees | 500+ |
✔️ GCR Rating | AA |
⚙️ Listed on the JSE | No |
🚩 JSE Stock Symbol | None |
📈 The most recent Market Cap reported | None |
📉 Average Customer Rating | 3/5 |
📊 Average Number of Reviews | 1,700+ |
✔️ Market Share | >10% |
6️⃣ Number of plans offered | 6 |
🚑 Number of Hospitals in Network | 100+ |
🏠 Home Care Provided | ✅ Yes |
❤️ Sponsorships | None |
📱 Mobile App | ☑️ Yes |
📖 GEMS Magazine for clients | No |
💻 Medical Claims Portal | ✅ Yes |
😷 Information Hub for COVID-19 | ☑️ Yes |
⚕️ Chronic Illness Benefits | ✅ Yes |
⚠️ Number of PMB Chronic Conditions | 69 |
➡️ Screening and Prevention offered | ☑️ Yes |
👶 Maternity Benefit | ✅ Yes |
💵 Medical Aid Contribution Range (ZAR) | 1,363 ZAR – 6,162 ZAR |
⛔ Average Waiting Period | Up to 12 Months |
📌 Late-joiner penalties charged | ☑️ Yes |
🌎 Is International Medical Cover offered | Scheme Rate, members pay and claim back from GEMS |
The Council for Medical Schemes regulates GEMS Medical Scheme. The Council governs South Africa’s medical plan business for Medical Schemes (CMS), a regulating body set up under the Medical Schemes Act, No. 131 of 1998 (the Act). The CMS is responsible for a range of tasks related to the oversight of medical insurance plans, such as:
Furthermore, if a medical scheme is found to violate the law, the CMS has the authority to issue administrative fines and penalties.
Gems Medical Aid Options
🔎 Plan | 💴 Contributions Range (Main) | 💵 Contributions Range (+ 1 Adult) | 💶 Contributions Range (+ 1 Adult & 1 Child) | 💷 Medical Savings (Up to) | 📌 Annual Hospital Benefit (Up to) | 📍 Chronic Conditions |
1️⃣ Tanzanite One | 1,363 – 1,778 ZAR | 1,077 – 1,505 ZAR | 587 – 852 ZAR | None | 271,180 ZAR | 31 |
2️⃣ Beryl | 1,538 – 2,187 ZAR | 1,534 – 2,187 ZAR | 863 – 1,241 ZAR | None | 1.2 million ZAR | 31 |
3️⃣ Ruby | 3,180 – 3,920 ZAR | 2,385 – 2,955 ZAR | 1,230 – 1,520 ZAR | 20% of contributions | · 100% of the scheme rate apply · Limited to PMBs · Subject to Managed Care Rules · Pre-authorization required · 100% cost, subject to PMB legislation · Subject to Annual Hospital Limit | 36 |
4️⃣ Emerald Value | 2,975 – 3,689 ZAR | 2,273 – 2,836 ZAR | 1,106 – 1,382 ZAR | None | · 100% of the scheme rate apply · Limited to PMBs · Subject to Managed Care Rules · Pre-authorization required · 100% cost, subject to PMB legislation · Unlimited Cover according to Scheme Rules | 69 |
5️⃣ Emerald | 3,554 – 4,410 ZAR | 2,707 – 3,381 ZAR | 1,319 – 1,649 ZAR | None | · 100% of the scheme rate apply · Limited to PMBs · Subject to Managed Care Rules · Pre-authorization required · 100% cost, subject to PMB legislation · Unlimited Cover according to Scheme Rules | 69 |
6️⃣ Onyx | 6,162 – 6,924 ZAR | 4,718 – 5,322 ZAR | 1,853 – 2,246 ZAR | None | · 100% of the scheme rate apply · Limited to PMBs · Subject to Managed Care Rules · Pre-authorization required · 100% cost, subject to PMB legislation | 69 |
Tanzanite One is an entry-level Network benefit option designed for employees at Levels 1 through 5 and subject to Network GP Nomination and Specialist Referral Rules. On Tanzanite One, you are offered Coordinated Care for improved health outcomes. You and each of your dependents are required to nominate a Network GP who will coordinate all your healthcare needs, leading to fewer out-of-pocket payments when visiting your Network GP.
The Tanzanite One network includes a selection of private hospitals. GEMS has negotiated agreed rates to provide quality healthcare to all members. Using GEMS Network providers and hospitals will not incur additional costs, allowing you to better care for your family. In addition, Tanzanite One members have access to the following:
Furthermore, members can expect the following In-Hospital Benefits:
Furthermore, members can expect the following Out-of-Hospital Benefits:
This is a Network benefit option designed for members with basic healthcare needs. It offers:
Furthermore, members can expect the following In-Hospital Benefits:
Furthermore, members can expect the following Out-of-Hospital Benefits:
This mid-level benefit option is designed for members with moderate healthcare needs who desire a Personal Medical Savings Account (PMSA). It offers:
Furthermore, members can expect the following In-Hospital Benefits:
Furthermore, members can expect the following Out-of-Hospital Benefits:
This high-level traditional benefit option is designed for members with moderate to extensive healthcare needs. It offers:
Furthermore, members can expect the following In-Hospital Benefits:
Furthermore, members can expect the following Out-of-Hospital Benefits:
This is an economical version of the Emerald option, designed for members with moderate to extensive healthcare needs. It offers:
Furthermore, members can expect the following In-Hospital Benefits:
Furthermore, members can expect the following Out-of-Hospital Benefits:
This healthcare option caters to members with high to extensive healthcare needs with:
Furthermore, members can expect the following In-Hospital Benefits:
Furthermore, members can expect the following Out-of-Hospital Benefits:
The Ruby option offered by GEMS includes a Personal Medical Savings Account (PMSA), comprised of 20% of the member’s contribution, and is held in their name. This account is designed to cover out-of-hospital or day-to-day medical expenses. Once the PMSA balance has been depleted, out-of-hospital claims will be covered by the limited block benefit. In addition, an annual PMSA statement, reflecting all transactions and entries made to the savings account, will be sent to the member when IT3(b) statements and tax certificates are issued. The Ruby, Emerald, and Onyx (REO) network is a specially curated network of healthcare providers, including general practitioners, specialists, and pharmacies, who have agreed to charge GEMS’ negotiated rate and abide by the managed care rules of the respective options.
To apply for Medical Aid through GEMS, you must Ensure that you qualify by using the “Do I qualify?” option on the GEMS website. If you qualify, you can download the application form.
When applying, the following should be noted:
Claims to GEMS can be sent in the following manner:
The scheme’s rules permit GEMS members, healthcare providers, and third parties to file complaints against the Scheme. If a third party is assisting the primary member, please indicate that you are filing a complaint on behalf of the primary member and verify that the member has given permission. The form is accessible at https://www.gems.gov.za/forms/benefitant-consent-form (titled Consent form authorizing GEMS to disclose personal information to a third party). Furthermore, parties can file a complaint through any of the following channels:
To ensure prompt resolution of written complaints, the following must accompany a complaint to GEMS:
The GEMS claims department will investigate the complaint and respond within 7 business days. However, some complaints may require further investigation and clinical input and may take longer to resolve. Members, healthcare providers, and third parties will be updated on the status of the complaint, and GEMS strives to resolve complaints quickly and effectively. Furthermore, suppose the initial response is unsatisfactory, and all efforts to resolve the issue within the scheme have failed. Then, the complaint may be escalated to the GEMS Dispute Committee in that case.
To switch your medical aid to GEMS, you can follow these steps:
Before switching to GEMS, you might have to serve a notice period with your current medical aid. It is recommended to check the terms and conditions of your current medical aid before making the switch.
READ more about our List of things to consider before cancelling our current medical aid
GEMS can be contacted in the following ways:
🔎 Medical Aid | 🥇 GEMS | 🥈 Medshield | 🥉 Fedhealth |
📌 Years in Operation | 18 Years | 55 Years | 87 Years |
👥 Average # Members | 1.8 million+ | 250,000+ | 150,000+ |
📊 GCR Rating | AA | AA- | AA- |
👤 Number of Employees | 500+ | 500 – 1,000 | 500+ |
📈 Market Share | >10% | <5% | <5% |
📉 Market Coverage | South Africa | South Africa | South Africa |
📍 Customer Rating | 3 | 3.5 | 3.5 |
📎 Number of reviews | 1,700+ | 900+ | 2,800+ |
📱 Mobile App | ✅ Yes | ✅ Yes | ✅ Yes |
💵 Contribution Range (ZAR) | 1,363 – 6,162 ZAR | 1,584 – 7,842 ZAR | 1,590 – 14,289 ZAR |
💶 International Travel Benefit (ZAR) | Scheme Rate – Members pay and claim back from GEMS | – | – |
Learn more in-depth the difference between Medshield and Fedhealth
GEMS is an excellent medical insurance program for government employees. There is a plan for everyone, with a range of cheap protection options. You will also have access to a selection of health programs designed specifically for government employees to help you better manage the stress of your job and live a healthier, happier life.
READ more about Health Insurance for your Pets
Excellent Choice.
I would like to express my sincere gratitude to the Gems referral board for granting me the waiver of the R12 000 co-payment for my wife’s treatment at the out-of-network hospital, Highveld Sub Acute. I appreciate your understanding of our situation and the predicament we faced. – Jane Winter
Fantastic Support.
I have only received the best level of support from GEMS. – Frankie Johns
Proud Member.
Due to a negative experience at Life Cosmos Hospital and my wife’s health decline, I reached out to Gems for assistance. After explaining the situation, Gems approved her admission to Highveld Sub Acute Hospital, where she received treatment for 20 days. Despite the constraints posed by the COVID-19 pandemic, the hospital informed Gems of my wife’s condition, and regular updates were communicated to me. I extend my heartfelt thanks to Gems for their prompt response and unwavering support throughout this process. The provision of an ambulance and the professional care provided by the hospital staff is highly commendable. I am proud to be a member of a medical aid that values its members and is always ready to listen and assist in times of need. – Maryam Camacho
✅ Pros | ❎ Cons |
Comprehensive coverage options that cater to different needs and budget | Restrictions in the network of healthcare providers that cater to specific plans |
Focus on preventative care, with perks like free health check-ups and flu vaccines | Higher monthly contributions for more comprehensive coverage options |
Option to choose a network of healthcare providers that align with the specific plan chosen | Claim submissions and payment validations can sometimes be slow and complicated |
Attractive discounts on various health-related products and services | Limited international cover for those who travel frequently |
Access to medical support and information through the 24-hour Healthline service | Some healthcare costs may not be fully covered and may require out-of-pocket payment |
Starting in January 2006, GEMS began actively enrolling new members. However, people the government does not currently employ cannot join GEMS.
During a waiting period, a member makes payments but doesn’t receive any benefits. A GEMS waiting period can be one of two types. Firstly, the GWP is up to three months. Then, there may be a CSWP (condition-specific waiting period) of up to a year.
Yes, GEMS can provide immediate cover. For example, suppose a new member enrolls in a program while suffering from a serious or terminal illness. In that case, they will be fully covered immediately.
GEMS is considered an affordable and comprehensive medical aid in South Africa, especially for government employees.
You can call GEMS on 0860 00 4367.
You can find the contact number for Service Providers on the website under “Healthcare Provider.” This service operates from Monday to Friday, 9 am to 4 pm.
You can view your GEMS funds on the member portal on the website or the mobile app. You can also opt into the SMS Benefit Check Service.
You can find the available options and their monthly contributions on the official GEMS website.
You will find the GEMS contribution calculator on the homepage underneath each of the six available plans offered by the scheme.
You can click on “Login” and choose “Member” from the options. You can click “Forgot Password” or “Retrieve Username,” depending on which you have forgotten or lost. Alternatively, contact GEMS’ customer support for assistance.
To downgrade your plan with GEMS, you must download and complete the “Motivation for options change form.”
If you want to add a child or adult dependent, you can log into your GEMS profile and Download the “Registration of Dependent(s) form” from the GEMS website.
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