GEMS Medical Aid Scheme

 

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

 

 

 

GEMS Review – Analysis of Medical Aids’ Main Features

 

1. ✅ GEMS at a Glance
2. ✅ GEMS Regulation
3. ✅ GEMS Plan Overview
4. ✅ GEMS – Advantages over Competitors
5. ✅ GEMS Medical Savings Account
6. ✅ How to apply for Medical Aid with GEMS
7. ✅ How to Submit a Claim with GEMS
8. ✅ How to Submit a Compliment or Complaint with GEMS
9. ✅ How to switch my Medical Aid to GEMS
10. ✅ GEMS Customer Support
11. ✅ GEMS vs Medshield vs Fedhealth – A Comparison
12. ✅ GEMS – Our Verdict
13. ✅ GEMS Member Reviews
14. ✅ GEMS Recent User Reviews
15. ✅ GEMS Pros and Cons
16. ✅ GEMS Frequently Asked Questions

 

 

GEMS Medical Aid at a Glance

 

🔎 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

 

 

GEMS Regulation

 

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:

 

• Responsible for registering medical insurance plans and ensuring they comply with the law and other laws.
• Making sure healthcare plans have the money to pay claims.
• Examining and authorizing proposed price hikes for medical plans.
• Accepting and examining member complaints and initiating disciplinary action against medical plans that violate the Act or other applicable rules.
• Helping medical insurance plans follow the law and other laws.

 

Furthermore, if a medical scheme is found to violate the law, the CMS has the authority to issue administrative fines and penalties.

 

 

Medical Aid GEMS Plan Overview

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

 

Overview

 

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:

 

• Comprehensive In-Hospital benefits for healthcare services provided by GEMS Network facilities, subject to a specified limit per family per year.
• GEMS Network providers, subject to Network GP nomination and Specialist Referral Rules, typically provide comprehensive Out-of-Hospital benefits for healthcare services.
• Tanzanite One GEMS Network providers and medicine are listed on the GEMS Formulary, which can be found on the GEMS website.
• Three additional non-PMB chronic conditions.
• Access to Public Facilities.

 

In-Hospital

 

Furthermore, members can expect the following In-Hospital Benefits:

 

• Prescribed minimum benefits (PMBs)
• Annual hospital benefit:
• Alcohol and Drug Dependencies
• Allied Health Services:
• Alternatives to hospitalization
• Blood services
• Dental services (conservative, restorative, and specialized)
• Emergency services (casualty department)
• GP and Specialist services
• Mental health
• Oncology (chemotherapy and radiotherapy)
• Organ and tissue transplants
• Pathology and Medical Technology
• Physiotherapy
• Medical and surgical appliances and prostheses
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis
• Surgical procedures (including maxillofacial surgery)

 

Out-of-Hospital

 

Furthermore, members can expect the following Out-of-Hospital Benefits:

 

• Allied health services
• Audiology, occupational therapy, and speech therapy
• Chronic Back and Neck Rehabilitation Program
• Circumcision
• Dental services (conservative dentistry, including acute medicine)
• Emergency assistance (road and air)
• GP and Specialist services
• HIV infection, AIDS, and related illnesses
• Infertility
• Maternity (ante- and post-natal care).
• Medical and surgical appliances and prostheses
• Mental health (Consultations, assessments, treatments, and counseling by GP, Psychiatrist, or Psychologist)
• Optical services (eye examinations, frames, lenses, permanent or disposable contact lenses, and acute medicine)
• Pathology and Medical Technologists
• Physiotherapy
• Prescribed medicine and injection material
• Preventative care services
• Screening services
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis

 

 

Beryl

 

Overview

 

This is a Network benefit option designed for members with basic healthcare needs. It offers:

 

• Comprehensive In-Hospital benefits for healthcare services provided by public and private hospitals, subject to a specified limit per family per year.
• GEMS Network providers, subject to Network GP and Specialist Referral Rules, typically provide comprehensive Out-of-Hospital benefits for healthcare services.
• Access to Beryl GEMS Network providers and medicine listed on the GEMS Formulary can be found on the GEMS website.
• Three additional non-PMB chronic conditions.
• Access to Public Facilities.

 

In-Hospital

 

Furthermore, members can expect the following In-Hospital Benefits:

 

• Prescribed minimum benefits (PMBs)
• Annual hospital benefit
• Alcohol and Drug Dependencies
• Allied Health Services
• Alternatives to hospitalization
• Blood services
• Dental services (conservative, restorative, and specialized)
• Emergency services (casualty department)
• GP and Specialist services
• Mental health
• Oncology (chemotherapy and radiotherapy)
• Organ and tissue transplants
• Pathology and Medical Technology
• Physiotherapy
• Medical and surgical appliances and prostheses
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis
• Surgical procedures (including maxillofacial surgery)

 

Out-of-Hospital

 

Furthermore, members can expect the following Out-of-Hospital Benefits:

 

• Allied health services
• Audiology, occupational therapy, and speech therapy
• Chronic Back and Neck Rehabilitation Program
• Circumcision
• Dental services (conservative dentistry including acute medicine)
• Emergency assistance (road and air)
• GP and Specialist services
• HIV infection, AIDS, and related illnesses
• Infertility
• Maternity (ante- and post-natal care)
• Medical and surgical appliances and prostheses
• Mental health (Consultations, assessments, treatments, and counseling by GP, Psychiatrist, or Psychologist)
• Optical services (eye examinations, frames, lenses, permanent or disposable contact lenses, and acute medicine)
• Pathology and Medical Technologists
• Physiotherapy
• Prescribed medicine and injection material
• Preventative care services
• Screening services
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis

 

 

Ruby

 

Overview

 

This mid-level benefit option is designed for members with moderate healthcare needs who desire a Personal Medical Savings Account (PMSA). It offers:

 

• Comprehensive In-Hospital benefits for healthcare services provided by public and private hospitals.
• Comprehensive Out-of-Hospital benefits for healthcare services.
• A PMSA and Block Benefit that funds selected In-Hospital and Out-of-Hospital healthcare services.
• A Family Practitioner Network Extender Benefit is activated once the PMSA and Block Benefit are depleted.
• Eight additional non-PMB chronic conditions.
• Access to Public Facilities.

 

In-Hospital

 

Furthermore, members can expect the following In-Hospital Benefits:

 

• Prescribed minimum benefits (PMBs)
• Annual hospital benefit
• Alcohol and Drug Dependencies
• Allied Health Services
• Personal Medical Savings Account (PMSA) and Block Benefits only.
• Alternatives to hospitalization
• Blood services
• Dental services (conservative, restorative, and specialized)
• Emergency services (casualty department)
• GP and Specialist services
• Mental health
• Oncology (chemotherapy and radiotherapy)
• Organ and tissue transplants
• Pathology and Medical Technology
• Physiotherapy
• Medical and surgical appliances and prostheses
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis
• Surgical procedures (including maxillofacial surgery)

 

Out-of-Hospital

 

Furthermore, members can expect the following Out-of-Hospital Benefits:

 

• Personal Medical Savings Account (PMSA) – 20% of contributions go towards the PMSA, available at the start of every year. Any funds left in the PMSA at the end of the year will be carried over to the next year.
• Allied health services
• Audiology, occupational therapy, and speech therapy
• Chronic Back and Neck Rehabilitation Program
• Circumcision
• Dental services (conservative dentistry including acute medicine)
• Emergency assistance (road and air)
• GP and Specialist services
• HIV infection, AIDS, and related illnesses
• Infertility
• Maternity (ante- and post-natal care).
• Medical and surgical appliances and prostheses
• Mental health (Consultations, assessments, treatments, and counseling by GP, Psychiatrist, or Psychologist)
• Optical services (eye examinations, frames, lenses, permanent or disposable contact lenses, and acute medicine)
• Pathology and Medical Technologists
• Physiotherapy
• Prescribed medicine and injection material
• Preventative care services
• Screening services
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis

 

 

Emerald Value

 

Overview

 

This high-level traditional benefit option is designed for members with moderate to extensive healthcare needs. It offers:

 

• Comprehensive In-Hospital benefits for healthcare services.
• Comprehensive Out-of-Hospital benefits for healthcare services.
• A Primary Care Extender Benefit and a Family Practitioner Network Extender Benefit are activated once the day-to-day Block Benefit is depleted.
• Forty-one additional non-PMB chronic conditions.
• Access to Public Facilities.

 

In-Hospital

 

Furthermore, members can expect the following In-Hospital Benefits:

 

• Prescribed minimum benefits (PMBs)
• Annual hospital benefit
• Alcohol and Drug Dependencies
• Allied Health Services
• Alternatives to hospitalization
• Blood services
• Dental services (conservative, restorative, and specialized)
• Emergency services (casualty department)
• GP and Specialist services
• Mental health
• Oncology (chemotherapy and radiotherapy)
• Organ and tissue transplants
• Pathology and Medical Technology
• Physiotherapy
• Medical and surgical appliances and prostheses
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis
• Surgical procedures (including maxillofacial surgery)

 

Out-of-Hospital

 

Furthermore, members can expect the following Out-of-Hospital Benefits:

 

• Allied health services
• Audiology, occupational therapy, and speech therapy
• Block Benefit (day-to-day benefit)
• Chronic Back and Neck Rehabilitation Program
• Circumcision
• Dental services (conservative dentistry including acute medicine)
• Emergency assistance (road and air)
• GP and Specialist services
• GP network extender benefit
• HIV infection, AIDS, and related illnesses
• Infertility
• Maternity (ante- and post-natal care).
• Medical and surgical appliances and prostheses
• Mental health (Consultations, assessments, treatments, or counseling by GP, Psychiatrist, or Psychologist)
• Optical services (eye examinations, frames, lenses, permanent or disposable contact lenses, and acute medicine)
• Pathology and Medical Technologists
• Physiotherapy
• Prescribed medicine and injection material
• Preventative care services
• Primary care extender
• Screening services
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis

 

 

Emerald

 

Overview

 

This is an economical version of the Emerald option, designed for members with moderate to extensive healthcare needs. It offers:

 

• Comprehensive In-Hospital benefits for healthcare services provided by GEMS Network facilities.
• GEMS Network providers, subject to Network GP nomination and specialist referral rules, typically provide comprehensive Out-of-Hospital benefits for healthcare services.
• Use of any doctor or drug on the GEMS Formulary list, as well as access to the Emerald GEMS Network’s roster of doctors, all through the GEMS website.
• Members on Emerald who opt for the Emerald Value Option (EVO) will benefit from reduced monthly contributions while retaining the same benefits as on the Emerald option but must nominate a Network GP.
• A Primary Care Extender Benefit and a Family Practitioner Network Extender Benefit are activated once the day-to-day Block Benefit is depleted.
• Forty-one additional non-PMB chronic conditions.
• Access to Public Facilities.

 

In-Hospital

 

Furthermore, members can expect the following In-Hospital Benefits:

 

• Prescribed minimum benefits (PMBs)
• Annual hospital benefit
• Alcohol and Drug Dependencies
• Allied Health Services
• Alternatives to hospitalization
• Blood services
• Dental services (conservative, restorative, and specialized)
• Emergency services (casualty department)
• GP and Specialist services
• Mental health
• Oncology (chemotherapy and radiotherapy)
• Organ and tissue transplants
• Pathology and Medical Technology
• Physiotherapy
• Medical and surgical appliances and prostheses
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis
• Surgical procedures (including maxillofacial surgery)

 

Out-of-Hospital

 

Furthermore, members can expect the following Out-of-Hospital Benefits:

 

• Allied health services
• Audiology, occupational therapy, and speech therapy
• Block Benefit (day-to-day benefit)
• Chronic Back and Neck Rehabilitation Program
• Circumcision
• Dental services (conservative dentistry including acute medicine)
• Emergency assistance (road and air)
• GP and Specialist services
• GP network extender benefit
• HIV infection, AIDS, and related illnesses
• Infertility
• Maternity (ante- and post-natal care).
• Medical and surgical appliances and prostheses
• Mental health (Consultations, assessments, treatments, or counseling by GP, Psychiatrist, or Psychologist)
• Optical services (eye examinations, frames, lenses, permanent or disposable contact lenses, and acute medicine)
• Pathology and Medical Technologists
• Physiotherapy
• Prescribed medicine and injection material
• Preventative care services
• Primary care extender
• Screening services
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis

 

 

Onyx

 

Overview

 

This healthcare option caters to members with high to extensive healthcare needs with:

 

• In-Hospital comprehensive benefits
• Out-of-Hospital comprehensive benefits
• Family Practitioner Network Extender Benefit after the day-to-day Block Benefit limit is reached
• Coverage for 41 extra non-PMB chronic conditions
• Access to Public Health Facilities.

 

In-Hospital

 

Furthermore, members can expect the following In-Hospital Benefits:

 

• Prescribed minimum benefits (PMBs)
• Annual hospital benefit
• Alcohol and Drug Dependencies
• Allied Health Services
• Alternatives to hospitalization
• Blood services
• Dental services (conservative, restorative, and specialized)
• Emergency services (casualty department)
• GP and Specialist services
• Mental health
• Oncology (chemotherapy and radiotherapy)
• Organ and tissue transplants
• Pathology and Medical Technology
• Physiotherapy
• Medical and surgical appliances and prostheses
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis
• Surgical procedures (including maxillofacial surgery)

 

Out-of-Hospital

 

Furthermore, members can expect the following Out-of-Hospital Benefits:

 

• Allied health services
• Audiology, occupational therapy, and speech therapy
• Block Benefit (day-to-day benefit)
• Chronic Back and Neck Rehabilitation Program
• Circumcision
• Dental services (conservative dentistry including acute medicine)
• Emergency assistance (road and air)
• GP and Specialist services
• GP network extender benefit
• HIV infection, AIDS, and related illnesses
• Infertility
• Maternity (ante- and post-natal care).
• Medical and surgical appliances and prostheses
• Mental health (Consultations, assessments, treatments, or counseling by GP, Psychiatrist, or Psychologist)
• Optical services (eye examinations, frames, lenses, permanent or disposable contact lenses, and acute medicine)
• Pathology and Medical Technologists
• Physiotherapy
• Prescribed medicine and injection material
• Preventative care services
• Primary care extender
• Screening services
• Radiology (advanced)
• Radiology (basic)
• Renal dialysis

 

 

GEMS – Advantages over Competitors

 

• GEMS is inexpensive. They provide a modest contribution increase, ensuring that you will continue to be able to afford your medical insurance throughout the years.
• In addition to being affordable, GEMS is easily accessible.
• GEMS provides high-quality healthcare through numerous networks.
• GEMS offers amazing perks to all its consumers. They have invested billions of Rands in claims for their beneficiaries. It is important to note that just 18% of their clients run out of claims at the end of the year. This is a low percentage compared to other medical schemes.
• GEMS provides six distinct alternatives that suit every type of lifestyle and budget.
• The GEMS website has a contribution calculator that is useful for estimating the amount of money you will need to contribute to your medical insurance. The contribution calculator considers the number of dependents you have, your salary, and your chosen option.
• The GEMS website is so intuitive that utilizing GEMS is a breeze.

 

 

GEMS Medical Savings Account

 

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.

 

 

How to apply for Medical Aid with GEMS

 

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:

 

• Do not hesitate to contact GEMS at 0860 00 4367 or [email protected] if you have not heard from the scheme within seven days of submitting your application.
• “Cooling-off period”: GEMS permits new members to cancel their membership within 15 days, provided no healthcare benefits have been claimed.
• Carefully review the terms and conditions on page 10 of the application form. They contain vital information on your application and GEMS membership.
• As a GEMS member, you and your registered dependents are bound by the Scheme Rules, which can be accessed at www.gems.gov.za.
• GEMS reserves the right to implement waiting periods according to the Scheme Rules.
• Gems medical aid contact number  confidential HIV/Aids 086 043 6736. Send a ‘please call me’ to 083 843 6764

 

 

How to Submit a Claim with GEMS

 

Claims to GEMS can be sent in the following manner:

 

• Physical copies can be handed in at GEMS walk-in centers
• Email to [email protected]
• Post to GEMS, Private Bag X782, Cape Town, 8000
• Fax to 0861 00 4367

 

 

How to Submit a Compliment or Complaint with GEMS

 

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:

 

• Email [email protected]
• Call GEMS on 0860 0043 67
• Post your complaint to GEMS, Private Bag X782, Cape Town, 8000
• Fax to 0861 00 43 67

 

To ensure prompt resolution of written complaints, the following must accompany a complaint to GEMS:

 

• The membership number or ID number is in the subject line.
• A comprehensive description of the issue and supporting documents (if available).
• Contact information, including phone number and email address, for follow-up communication.
• The practice name, practice number, and service date (if applicable).
• Details of the disputed claim (if applicable).

 

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.

 

 

How to switch my Medical Aid to GEMS

 

To switch your medical aid to GEMS, you can follow these steps:

 

• Review the options GEMS offers and choose the one that best suits your needs.
• Obtain a quote from GEMS and compare it with your current medical aid.
• Complete the GEMS application form and provide all the required information and documentation.
• Wait for approval from GEMS. Furthermore, this may take a few days or a week.
• Notify your current medical aid of your decision to switch to GEMS. You will need to complete a cancellation form and provide a copy of your approval letter from GEMS.
• Wait for your current medical aid to confirm the cancellation of your membership.
• Begin using your GEMS medical aid as soon as it becomes active.

 

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 Customer Support

 

GEMS can be contacted in the following ways:

 

• Call the call center on 086 00 4367, Mondays to Fridays from 8 am to 5 pm, and Saturdays from 8 am to noon.
• Call 080 044 4367 Monday to Sunday in an emergency (available 24/7).
• For general inquiries, send a letter to GEMS at Private Bag X782, Cape Town, 8000.
• Email GEMS at [email protected].
• Fax GEMS at 086 100 4367.
• Visit one of the Walk-in centers across South Africa.
• View the GEMS website for specific department contact details.

 

 

 

GEMS vs Medshield vs Fedhealth – A Comparison

 

🔎 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 – Our Verdict

 

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

 

GEMS Member Reviews

 

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

 

 

 

GEMS Pros and Cons

 

✅ 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

 

 

GEMS Frequently Asked Questions

 

Is GEMS only available to Government Employees in South Africa?

Starting in January 2006, GEMS began actively enrolling new members. However, people the government does not currently employ cannot join GEMS.

 

What is the waiting period for 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.

 

Does GEMS cover immediately?

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.

 

Is GEMS medical aid good?

GEMS is considered an affordable and comprehensive medical aid in South Africa, especially for government employees.

 

What is the GEMS Medical Contact Number in South Africa?

You can call GEMS on 0860 00 4367.

 

Where can I find the GEMS contact number for Service Providers?

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.

 

Where can I view my GEMS available funds?

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.

 

Where can I find the GEMS Options and Prices?

You can find the available options and their monthly contributions on the official GEMS website.

 

Where can I find the GEMS calculator for 2023?

You will find the GEMS contribution calculator on the homepage underneath each of the six available plans offered by the scheme.

 

What happens if I forget my GEMS login?

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.

 

How to Downgrade my Plan with GEMS?

To downgrade your plan with GEMS, you must download and complete the “Motivation for options change form.”

 

How do I add a Beneficiary to GEMS?

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.