Medihelp Pensioners Migrated to Gems

The Employer (Government) has taken the decision to migrate a group of State pensioners, who retired before 1 July 1992 from the Public Service, from Medihelp to the Government Employees Medical Scheme (GEMS) with effect from 1 April 2012. The members who will be migrating have been issued new GEMS membership numbers. In order to assist GEMS in making this …

2016 GEMS GP Tariffs (SAPPHIRE & BERYL)

As per communique from GEMS (SAPPHIRE & BERYL) 2016 Tariffs 3. Tariff changes for 2016Please be advised of the following changes for 2016: An increase of 5.5% in professional fees for doctors participating in the GEMS FP network. Kindly note that with effect from 1 January 2016, the following fees and tariffs will be applicable to Sapphire and Beryl network …

Sustainability of (Government Employees Medical Scheme) GEMS

http://medinol.co.za/government-employees-medical-scheme-gems-faces-insolvency-threat/   ***************************************** Kindly peruse the attached response from GEMS(Government Employee Medical Scheme) regarding the articles published in the media on Monday, 22 August 2016, which questions the financial sustainability of scheme. ******************************** Dear Service Provider The Scheme is aware of the article published in Business Day on 22 August 2016 and the Scheme would like to respond to some …

GEMS – Dispensing Doctor Claims Processing

Please be advised that since 1 January 2016 GEMS has been processing claims via Medikredit.   New submitting codes for the submission of dispensing doctor claims have been assigned and have been updated in the Medprax data files.   Please note the Dispensing fee for Gems SEP and Non-SEP items is as follows:   Amount Range (Incl. VAT) Dispensing Fee (incl.VAT) …

Government Employees Medical Scheme (GEMS) faces insolvency threat

The Government Employees Medical Scheme (GEMS) could be insolvent by financial year-end if drastic cost-containment measures are not instituted, reports Business Day. This would mean the scheme would need to be bailed out by the Treasury or amalgamated into a different scheme, forcing significant changes in benefits for its 1.8m members. The report said it would be a big blow to those in government who …

GEMS Bemoans Inappropriate ICD-10 Z-Code Usage

Dear Doctor THE INAPPROPRIATE USE OF Z-CODES IN CLAIMS SUBMITTED TO THE SCHEME It is almost a year since GEMS’ communication to healthcare practitioners encouraging the use of specific ICD-10 Codes on claims submitted to the Scheme. The recent GEMS audit done on claims received to date indicates the continued use of Z-Codes on a number of claims that have …