Company Research Report: Government Employees Medical Scheme (GEMS)

Company Overview

Name

• Government Employees Medical Scheme (GEMS)

Mission

• To provide all members with equitable access to affordable and comprehensive healthcare, promoting member wellbeing.

Founding and Founders

• Founded: 1 January 2005.

• Founders: Developed following a policy framework approved by the Cabinet in 2002 by an interdepartmental working group including the departments of Public Service and Administration, National Treasury, Health, Education, Correctional Services, and SAPS.

Key People

• Chairman of the Board: Dr. Nomzamo Tutu

• Principal Officer: Dr. Stan Moloabi

• Chief Operations Officer: Dr. Vuyokazi Gqola

• Chief Financial Officer: Mrs. Karyna Van Lingen

Headquarters

• Location: No specific headquarters location provided.

Number of Employees

• No information is available.

Revenue

• No information is available.

Known For

• GEMS is South Africa's largest restricted medical scheme, offering healthcare coverage to over 800,000 principal members and 2 million beneficiaries, primarily focusing on public service employees.

Products

Tanzanite One

• Description: Previously known as Sapphire, this option covers comprehensive in-hospital and out-of-hospital benefits within the GEMS network of private hospitals.

• Key Features:

• Comprehensive cover with no out-of-pocket payments for network services.

• Unlimited GP and specialist consultations.

• Subsidy of up to 100% for certain members.

Beryl

• Description: Provides access to both public and private healthcare facilities with a focus on network hospitals.

• Key Features:

• Comprehensive in and out-of-hospital benefits.

• No mandatory GP nomination but incentives for coordinated care.

• Shared payment model with 70% of expenses covered.

Ruby

• Description: Includes a Personal Medical Savings Account (PMSA) for out-of-hospital expenses.

• Key Features:

• Savings account holds 20% of contributions for medical expenses.

• Access network of GPs and specialists without out-of-pocket expenses.

• Pre-authorisation required for hospital and specialised services.

Emerald Value

• Description: Offers comprehensive coverage with a focus on affordability through designated GP and hospital networks.

• Key Features:

• Requirement to nominate a GP within the GEMS network.

• Co-payment for non-nominated GP visits.

• Specialist referrals through nominated GP only.

Emerald

• Description: Comprehensive in-and-out-of-hospital cover allowing choice in healthcare providers.

• Key Features:

• Use of REO network adhering to GEMS rules.

• Encouragement for nominating a GP for coordinated care.

• Pre-authorisation needed for hospital admissions and specialised services.

Onyx

• Description: Provides extensive in-and-out-of-hospital cover with premium benefits.

• Key Features:

• Encouragement to nominate a GP within the REO network.

• Comprehensive network of GPs and specialists.

• Pre-authorisation required for hospital and diagnostic services.

Recent Developments

Recent Developments

• Switch from Emerald to EVO: A campaign encouraging members to switch for better savings and benefits.

• Member App Launch: Available on Huawei AppGallery, allowing real-time updates and access to membership e-cards.

New Products Launched

• No information is available.

New Features

• No information is available.

Partnerships

• Partnering with private hospitals to create additional revenue streams for public healthcare facilities through the Tanzanite One option.

This report comprehensively details the structure and offerings of GEMS based on the available data without additional commentary or conjecture.