GEMS medical scheme contributions in South Africa in 2023. by plan

* GEMS stands for the Government Employees Medical Scheme and is the largest restricted medical scheme in South Africa

Restricted medical schemes are only available to people who work in specific industries, have certain academic qualifications, are employees of a certain company or belong to certain professional associations in South Africa.

The cheapest plan (Tanzanite One) covers all in-hospital benefits for both public and private hospitals which are listed of the GEMS network. The Onyx option covers additions out of hospital benefits which are not listed on the GEMS network.

South African medical schemes are non-profit trusts that their members own. The contributions made by the members are put together and used to pay pertinent medical costs where necessary while keeping a legislated surplus (at least a 25 percent solvency ratio) to prevent the scheme from collapsing. Some medical plans have an option for saving, which creates a collective savings from a member’s monthly payments for personal use.

Medical aid schemes are required by law to cover a set list of chronic illnesses, namely the Prescribed Minimum Benefits (PMB).This safeguards all medical scheme members so that they have access to the minimum amount of health services, regardless of which benefit option they have chosen. Furthermore, medical schemes are allowed to have different product plans, which often target specific demographics. For example: specialized benefits, annual limits, day-to-day coverage, family cover, and networked doctors and hospitals all differ across the various plans, both internally and from company to company.