Find a medical scheme that truly has your health at heart

Your health and that of your family is your most precious asset. That is why your contribution towards your healthcare cover every month is one of the most important investments you make.

Liziwe Nkonyana, Executive, Communication and Member Affairs at Government Employees Medical Scheme (GEMS), says that for most of us medical scheme membership is something of a grudge purchase because it is a type of insurance against the possibility of a healthcare event, which is never a pleasant thing to consider.

“It is important to be prepared for such an eventuality, however, particularly as there are few more important things than the health and wellbeing of you and your family. There are therefore few more potentially critical decisions you can make than the scheme and benefits you choose,” points out Nkonyana.

But, are you always getting the very best value for money when it comes to healthcare services, and more specifically, healthcare benefits?

Nkonyana says that when choosing a medical scheme, the points below should be considered so that you can select the right scheme and make the most of your medical scheme benefits.

How affordable is your medical scheme?

“Sometimes your finances will determine what option and which scheme you can afford to belong to. However, when comparing the different costs of medical schemes, always ensure that you are comparing apples with apples and that you take into account all thenecessary benefits. And remember, it is always better to choose the cover that is most appropriate to meet your needs and your pocket.

“GEMS has always made an effort to deliver the finest possible healthcare benefits at the most affordable rates to its members. Contribution rates on GEMS benefit option plans are maintained at 19% below those of similar benefit plans offered by other medical schemes while offering similar or better benefits,” adds Nkonyana.

Are you getting value for money?

Always enquire what the average scheme increases were over the past five years. Check if benefits were decreased or increased as some schemes may well reduce benefits while increasing contributions.

At 7.4% the non-healthcare expenditure of GEMS, which includes administration costs, is substantially lower than the industry average of 11.8%. This careful management of the Scheme has resulted in savings of R1.2 billion. The funds saved by the scheme have allowed us to fund more healthcare services forour members.

Going an extra mile for our members

To date, through the GEMS Ex-gratia Committee over 25.4 million in 2015funding applications received from members who incurred expenses that are not available as part of their benefits have been reviewed and approved.

How do your benefits square?

Nkonyana says you should check what you are covered for and whether your scheme will apply a waiting period in your particular case.

“Do not be caught short when you finally need your healthcare cover in the event of a major healthcare event. For this reason, make sure that you know exactly what you are covered for and choose a benefit that meets your and your family’s needs.

“Keep in mind that some benefit options do place limitations on hospitalisation. This is one of the reasons why you should check that the benefits offered will meet your specific needs and requirements.”

How well do you understand your benefits?

“Make sure you understand your medical scheme and its different benefit options. Read the membership guide and brochures, and familiarise yourself with the scheme rules,” says Nkonyana.

“If you do not understand certain of the benefits or rules, insist on a comprehensive explanation. And remember, the membership guide will not only give you important information regarding general procedures to be followed, but also very specific information regarding the extent of medical cover available to you.”

Is your medical scheme responsive to the needs of its members?

“Some schemes are more responsive to their members’ opinions and needs than others are. How well does the scheme communicate with members and does it speak to members in a manner that is easy to understand?”

“At GEMS, we communicate in a way that is easy to digest and understand. We have also developed a number of walk-in centres around the country to get closer to our members and assist them with their queries.  In addition, members complete regular surveys that are undertaken in order to assess service and research the opinions of individual government departments, members and service providers.”

The scheme of choice for Government employees

“Well over 530 000 members are contacting the GEMS call centre monthly, while at least 47 000 visit our regional walk-in centres around South Africa. As many as 90% of GEMS members are now located within 10 kilometres of a GEMS healthcare network provider,” says Nkonyana.

“Those who are government employees and have not yet made the move to GEMS are missing out on an important employee benefit. With approximately 1,76 million covered lives, GEMS has enjoyed unprecedented growth year after year precisely because we offer good value, great benefits and accessibility,” she concludes.