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GEMS Payment Runs 2025

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GEMS payment runs 2025: what providers need to know

GEMS payment runs 2025 is a critical topic for any healthcare provider that bills the Government Employees Medical Scheme. Timely payments keep cash flow steady, reduce administrative follow up, and improve the provider experience. This article explains where GEMS publishes its payment run information, the scheme plans that generate these claims, what payment runs mean to providers, how significant GEMS is for patient volumes, and the best contacts for support.

Where to find GEMS payment runs 2025

GEMS publishes provider guidance, tariff files, and operational notices on its Healthcare Providers pages and via the provider login and practitioner app. For the official calendar of payment runs for 2025 providers must use the GEMS provider channels. The primary provider entry point is the Healthcare Providers page at: https://www.gems.gov.za/healthcare-providers/ That page contains links to provider guides, tariff files, ICD10 codes, and the practitioner app. GEMS usually posts payment run schedules, exceptions and any changes on the provider portal or via direct provider communications. If you need the official, up to date payment run calendar for 2025 check the provider portal or contact provider services directly.

GEMS plans and how they affect payment flows

GEMS operates six core benefit options. The plans influence claim types, authorisation workflows, and how payments are processed.

The main GEMS plans are:

  • Tanzanite One: entry level care coordinated network option with defined hospital networks and limited out of hospital benefits.
  • Beryl: entry level network option with in hospital benefits subject to annual limits.
  • Ruby: a mid level savings option with a savings account and block benefit for day to day items.
  • Emerald Value: a high level care coordinated network option that uses networks for hospital and primary care.
  • Emerald: a high level benefit option with comprehensive in hospital benefits and day to day day to day block benefits.
  • Onyx: the top level benefit option with comprehensive hospital and high value day to day benefits.

Different plans mean different claim authorisation and verification steps. For example claims originating from network managed benefit options may require pre authorisation and use contracted tariffs. Savings linked plans may route components of a claim to the savings account and the balance to the main scheme account. This affects how claims are validated and when they clear for payment in the scheduled runs.

What GEMS payment runs 2025 means to providers

Payment runs are the scheduled batch processes where validated claims are paid.

For providers this matters in several ways:

  • Cash flow predictability. Knowing the payment run schedule helps practices manage payroll and supplier payments.
  • Reconciliation. Matching remittance advices to bank credits is far easier when you can align them to a known run date.
  • Authorisation timing. Claims that need pre authorisation or additional supporting clinical notes may miss a payment run and be paid a month later. Getting authorisations approved in advance reduces delays.
  • Administrative overhead. Understanding payment cadence lowers the need for follow up calls and dispute management.

Because GEMS is a restricted medical scheme focused on public service employees GEMS volumes can be large for certain practice types. Payment timing therefore has an outsized effect on clinics that regularly treat GEMS members.

How significant is GEMS in terms of patient volume

GEMS is one of the largest medical schemes in South Africa by membership. The scheme serves hundreds of thousands of principal members and around two million beneficiaries in total. That scale makes GEMS a material payer for many primary care clinics, specialists and private hospitals. For practices located near government departments and public sector concentrations GEMS patients may represent a substantial share of daily consults. This makes accurate understanding of GEMS payment runs 2025 essential for practices that rely on GEMS revenue.

Provider portal and practitioner app

GEMS supports providers via online guides and a practitioner app. Use the Healthcare Providers page to access provider resources and to locate the practitioner app and portal access. The provider page URL again is: https://www.gems.gov.za/healthcare-providers/ If you are a registered GEMS provider sign in to the portal or download the practitioner app to view payment run calendars, remittance advices, tariff files, and clinical rules.

GEMS provider contact details and support

For official information about GEMS payment runs 2025 and any year specific schedules the fastest route is provider services.

GEMS provider contact details are:

If you are a provider with urgent payment or remittance queries call the provider call centre and have your practice details and claim references ready. For non urgent matters use the provider email and attach remittance advices or claim examples to speed resolution.

Practical next steps for providers

1) Check the provider portal and practitioner app for the official GEMS payment runs 2025 calendar and remittance notices.
2) Submit claims with full authorisations and supporting documentation where required to avoid missing a payment run.
3) Reconcile remittances against bank statements and flag unexplained shortfalls with provider services promptly.
4) Keep tariff files and clinical guides up to date from the GEMS provider resources to reduce rejections.

GEMS payment runs 2025 are a key operational concern for practices that serve public sector employees. Because GEMS has significant membership and patient volume the timing and reliability of payment runs directly affects provider cash flow and administration. Use the GEMS Healthcare Providers page and practitioner app to access the official payment run calendar and resources. For direct support call 0860 43 6777 or email enquiries@gems.gov.za. Checking the portal regularly will ensure you get the definitive GEMS payment runs 2025 dates and avoid payment surprises.

Courtesy of Medinol Best Medical Billing Software South Africa

KeyCare Plus

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Who is Keycare Plus

Keycare Plus is a network based medical aid option widely recognised in South Africa for balancing cost and access to private healthcare. Offered through one of the countrys major healthcare administrators, Keycare Plus aims to make essential private care affordable by steering members to a specified network of providers while still delivering clinically relevant cover. This piece outlines where Keycare Plus fits into the local healthcare system, the main pros and cons, who the option suits best, and how to get support or contact the provider.

What is Keycare Plus

Keycare Plus is designed as a managed care option. Instead of offering unrestricted access to any private provider, Keycare Plus uses a defined network of hospitals, doctors and allied providers to manage costs and maintain consistent standards of care. Members get cover for acute episodes, hospital admissions and selected procedures when they use network providers. Non network care may be subject to limited reimbursement or pre authorisation requirements, so staying inside the network is important for predictable benefits.

Where Keycare Plus fits in the South African healthcare system

South Africas private healthcare market relies on a mix of open indemnity options and managed care network options. Keycare Plus sits within the managed care category. Its role is to provide an affordable alternative to fully open plans while preserving access to private hospital and specialist care when clinically necessary. For medical schemes and administrators, Keycare Plus reduces claims volatility and supports better cost management. For providers, it creates a steady patient stream from contracted networks and encourages adherence to agreed clinical pathways.

Pros of Keycare Plus

  • Lower premiums compared to open indemnity plans. For many households this makes private healthcare viable.
  • Predictable benefits when members use the specified network. This simplifies authorisation and claims processing.
  • Emphasis on managed care protocols which can support evidence based pathways for common conditions.
  • Network collaboration can speed up approvals for clinically necessary procedures and simplify invoicing.
  • Suitable benefit packages for acute care including hospital admissions and common procedures.

Cons of Keycare Plus

  • Restricted choice of providers. Members who prefer a particular specialist or hospital outside the network may face limited reimbursement.
  • Potential out of pocket expenses if members go out of network without pre authorisation.
  • Some complex or highly specialised treatments may need referrals or additional approvals that delay access.
  • Members who travel frequently or live in areas without network providers may find access inconvenient.

Who is the target market for Keycare Plus

Keycare Plus primarily targets members who are cost conscious yet want access to private healthcare for acute episodes and hospital care.

Typical profiles include:

  • Families seeking lower monthly contributions while retaining private sector access.
  • Young professionals and small businesses that want affordable cover for emergencies.
  • Members prepared to use network doctors and hospitals in exchange for lower premiums.
  • Practices and medical bureaus that work within scheme networks and can help members navigate authorisations.

Practical considerations for members and providers

  • Check the network list before joining. Confirm which hospitals and specialists are included in your location.
  • Always obtain pre authorisation for planned admissions or surgical procedures. This avoids unexpected shortfalls.
  • Keep copies of referral letters, radiographs and clinical notes to support claims.
  • If you are a provider, verify authorisation and benefit rules before performing non urgent work to reduce claim rejections.

Contact details and support

For the most accurate, up to date contact channels and support options for Keycare Plus, visit the administrators official website and the Keycare Plus product page. The administrators maintain a contact us page and a member portal for claims tracking, authorisation requests and policy information. Members should also refer to their membership card or scheme documentation which lists the correct telephone numbers and email addresses for support.

Who to contact for support

  • For new enquiries and sales information use the product or contact pages on the administrators website.
  • For existing members needing claims assistance, authorisations or account queries use member services via the online portal or the listed member support phone and email on your membership materials.
  • If you are a healthcare provider contact the administrators provider relations or network management team listed on the website for contracting, billing and clinical pathway queries.

Final notes on choosing Keycare Plus

Keycare Plus can be a strong choice when affordability and access to private acute care are priorities. It works best for members who are comfortable using a managed network and who value lower monthly premiums. Before you commit, confirm network coverage for your preferred hospitals and specialists and understand the authorisation rules that apply to planned care.

Administrator

  • Discovery Health (Pty) Ltd — administrator for Discovery Health Medical Scheme and the Keycare Plus product.

Official product page

Primary contact channels

  • Phone Get Help line: 0860 99 88 77
    Operating hours: 07:00 to 20:00 Monday to Friday, 08:00 to 13:00 Saturday. Closed Sundays and public holidays.
  • Online Get Help service and WhatsApp chat: available via Discovery website (use the Get Help link at the top of the site).
  • Visit a Discovery Store: use the Discovery website to find your nearest store and book in person help.

Email and direct support

  • Discovery does not publish a single public support email for Keycare Plus on the product pages. Members and providers are directed to use the Get Help service, the member portal or the WhatsApp channel for fastest response.
  • For general corporate enquiries the site references info channels and contact forms rather than a single public support email. If you want the exact scheme or provider support email for Keycare Plus  check the member portal and provider administration sections and return the verified address.

Provider and technical support

  • Providers should use the Provider Administration section on Discovery’s site or the provider portal for contracting, claim queries and authorisations. If you cannot find the provider email on the public pages I can look up the provider relations contact details for you.

MediSwitch

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Who is MediSwitch

MediSwitch is a well established South African company that provides electronic claims switching and related healthcare administration services. Over time MediSwitch has been closely associated with broader health technology offerings and industry partners that enable medical schemes, medical bureaus, healthcare providers, and insurers to process claims efficiently and securely. This writeup gives a concise overview of what MediSwitch does, how it fits into the healthcare ecosystem in South Africa, and where to go for support and contact information.

What MediSwitch does

MediSwitch operates at the intersection of healthcare administration and technology. The core service is electronic claims switching, which means routing clinical and billing data between healthcare providers and medical aid schemes in a secure and standardised way. This reduces manual paperwork, speeds up claims processing, and lowers administrative overhead for clinics, hospitals, and medical bureaus. MediSwitch also supports value added services such as practice management integration, reporting tools, and services that help maintain regulatory compliance for healthcare providers.

How MediSwitch fits into the South African healthcare industry

In South Africa, claims switching is a vital behind the scenes function. Hospitals, private practices, dental surgeries, allied healthcare providers, and medical schemes all rely on fast and accurate claims exchange to maintain cashflow and ensure correct reimbursements. MediSwitch acts as the technical bridge that connects practice management systems and electronic health records with scheme administrators and insurers. By providing secure data exchange, MediSwitch helps healthcare organisations focus on patient care while the administrative processes run reliably in the background.

MediSwitch also partners with other technology vendors and bureaus to provide a more complete offering. These partnerships can include practice management platforms, electronic health record providers, and analytics services. For providers who want to digitise their practice, adopt electronic claims, or reduce the time spent on billing and follow up, MediSwitch is one of the key services referenced by industry stakeholders.

Benefits for healthcare providers

  • Faster claims processing and reduced turnaround time for payments.
  • Fewer claim rejections due to standardised data formats and validation checks.
  • Reduced administrative burden so staff can focus more on patient care.
  • Improved audit trail and reporting for compliance and financial oversight.
  • Integration options with practice management software and electronic health records.

Who should consider MediSwitch MediSwitch is relevant to doctors, dentists, physiotherapists, allied health professionals, clinics, and medical bureaus that submit claims to medical schemes or insurers. It is also relevant to administrators within larger healthcare enterprises that need robust claims switching and data exchange services.

Support and contact details If you need support or want to learn more about MediSwitch services, the primary contact route is through the company now operating under the Altron HealthTech group, which manages claims switching, practice management solutions, and related healthcare technology services.

Headquarters

Altron Woodlands Campus
20 Woodlands Drive
Building H, 2nd Floor
Woodlands Office Park
Woodmead 2191

Main contact options

Ethics and whistleblower line

How to get help

  • New customers and prospective partners can use the Contact Us form on the Altron HealthTech website to request demonstrations and information about MediSwitch related services.
  • Existing customers should contact Sales, Accounts and Support at 010 449 1000 for technical support, account queries, and urgent help with claims switching or integration issues.
  • If you need to report compliance concerns or whistleblower matters use the Altron Ethics Line.

Practical tips when working with MediSwitch

  • Make sure your practice management software is configured to send standardized claim formats. This reduces rejections.
  • Keep supporting documentation like radiographs and clinical notes ready when submitting complex or surgical claims.
  • Use the customer portal if available to track claim statuses and reports. Many providers find the portal speeds up reconciliation.
  • For urgent outages or system issues call the support number so the technical team can act quickly.

MediSwitch is a core component in the South African healthcare claims ecosystem. By enabling secure and reliable electronic claims switching and by working with Altron.com. For new enquiries, use the Altron HealthTech contact form or call the same support number to request a demo or get setup assistance.

Brought to you by Medinol Medical Billing Software

Medical Aids on Solvency Watchlist

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Three medical aids fail to maintain required liquidity

The solvency rate of medical aids is down but, at 43%, is higher than the required minimum – except for three: Medihelp, Sizwe Hosmed Medical Scheme and Transmed Medical Fund, which all failed to maintain their solvency ratios at or above 25% in 2023, reports Moneyweb.
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The Half-a-Percent VAT Debacle – Effect on Healthcare Providers

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person wearing lavatory gown with green stethoscope on neck using phone while standing

Tax Turmoil & Treatment Troubles: How VAT Debates Shake South Africa’s Healthcare Foundation

South Africans are no strangers to economic anxiety. Rising living costs, fuel price hikes, and uncertainty about the future weigh heavily. Imagine, then, the collective sharp intake of breath when whispers – or sometimes louder discussions – emerge about potential tax increases, like a hike in Value Added Tax (VAT). Recently, the idea of a 0.5% VAT increase, potentially earmarked for crucial services like the National Health Insurance (NHI), has entered the national conversation, only for such definitive proposals to seemingly evaporate or be officially walked back, leaving confusion and concern in their wake.

This policy uncertainty isn’t just an economic headline; it sends ripples, even shockwaves, through vital sectors. Perhaps none is more sensitive to these tremors than South Africa’s already strained healthcare environment.

But what exactly does a potential VAT hike, even one discussed and then shelved, mean for private healthcare providers and the ambitious goals of the NHI? Let’s unpack the complex relationship between VAT policy and the health of the nation.

Understanding the South African Healthcare Context

Before diving into VAT specifics, it’s crucial to remember the landscape:

A Two-Tiered System: South Africa operates a starkly divided healthcare system. A well-resourced, but expensive, private sector serves a minority (around 16-20% of the population, primarily those with medical aid). The vast majority rely on the public sector, which faces significant challenges: underfunding, staff shortages, aging infrastructure, and often, long waiting times.

National Health Insurance (NHI): The government’s flagship policy aims to bridge this divide by creating a single, mandatory health insurance fund. The goal is universal access to quality healthcare for all citizens, regardless of their socio-economic status. However, the big question mark has always been: how will it be funded?

Why VAT Enters the Healthcare Funding Conversation

Funding the NHI adequately is a monumental task, estimated to require hundreds of billions of Rand annually. Government needs sustainable revenue streams. VAT is often considered because:

Broad Base: It’s levied on a wide range of goods and services, potentially generating significant revenue even with a small percentage increase.

Existing Infrastructure: The collection mechanism (via SARS) is already in place.

The logic follows that a dedicated portion of an increased VAT could be ring-fenced for the NHI fund, providing a predictable income stream to start tackling the public sector’s deficits and rolling out NHI services. A 0.5% increase might seem small, but it could translate into billions.

(Context Note: South Africa last increased its standard VAT rate from 14% to 15% in April 2018, a move that was also met with considerable debate about its impact on the poor).

The Ripple Effect: Potential Impacts of a VAT Increase (Even if Proposed and Retracted)

Even the discussion of a VAT hike, let alone its implementation, has consequences. If a 0.5% increase were implemented for healthcare funding, here’s how it could play out:

Increased Operational Costs:

Medical Supplies & Equipment: While some basic foodstuffs are zero-rated for VAT, many essential medical supplies, pharmaceuticals, and sophisticated equipment are not. A VAT increase directly inflates the cost of these items for both public and private hospitals and clinics. This includes everything from bandages and syringes to MRI machines and chemotherapy drugs. Even zero-rated final products might see price increases if the inputs used to make them incur higher VAT.

Running Expenses: Utilities, maintenance services, administrative supplies – the day-to-day running costs of healthcare facilities would also rise, putting further pressure on already tight budgets, especially in the public sector.

Impact on Patients:

Private Healthcare Costs: Medical aid premiums would likely increase as insurers pass on the higher costs of services and supplies. Out-of-pocket expenses (co-payments, non-covered treatments) would also rise. This could make private healthcare even less affordable, potentially pushing more people towards the strained public system.

Direct Costs: Even in the public sector, patients might face slightly higher costs for any non-essential items or services that aren’t fully subsidised. More broadly, the general inflationary pressure from a VAT hike reduces disposable income, making it harder for families to afford transport to clinics, healthier food, or over-the-counter medications.

The NHI Funding Paradox:

Intended Benefit: The core goal would be increased, dedicated funding for NHI, enabling investment in public facilities, hiring more staff, and expanding service availability.

Potential Drawback: If the VAT increase significantly dampens economic growth or disproportionately hurts the poor (VAT is regressive – it takes a larger percentage of income from low-earners), it could undermine the very socio-economic upliftment that improved healthcare aims to support. It also raises costs within the system it’s trying to fund.

The Damage Done by Policy Uncertainty (The “Retraction” Factor)

When a potential policy like a VAT hike is floated and then seemingly withdrawn or lacks clear governmental backing, it creates a damaging environment of uncertainty:

Planning Paralysis: Hospitals, clinics, medical aid schemes, pharmaceutical companies, and suppliers struggle to budget and plan for the future. Should they factor in higher costs or not? This hesitation can stifle investment and innovation.

Erosion of Trust: Constant back-and-forth on critical funding mechanisms erodes public and investor confidence in the government’s ability to manage the economy and implement complex reforms like NHI effectively.

Delayed NHI Implementation: Funding uncertainty is a major roadblock for NHI. Without a clear, agreed-upon, and sustainable funding model, progress remains slow, leaving the structural problems of the current system unresolved.

Increased Anxiety: For ordinary citizens, particularly those reliant on the public sector or struggling to afford medical aid, this uncertainty adds another layer of stress regarding future healthcare access and affordability.

Finding a Sustainable Path Forward

The debate around a VAT increase highlights the critical need for a transparent, stable, and economically sound funding model for South Africa’s healthcare ambitions. While VAT is one tool, relying solely on it, especially given its regressive nature, is problematic.

Other potential funding sources often discussed include:

  • Adjustments to personal income tax brackets.
  • A dedicated payroll tax (for employers and/or employees).
  • Reallocation of funds from existing medical aid tax credits.
  • Sin taxes (on alcohol, tobacco, sugar).
  • Improved efficiency and reduced wastage/corruption within the current health budget.

Ultimately, the solution likely lies in a blend of sources, combined with demonstrable improvements in governance and efficiency within the Department of Health and the future NHI fund.

Stability is Non-Negotiable

The discussion around a 0.5% VAT increase and its subsequent retraction (or lack of firm proposal) serves as a stark reminder of how sensitive South Africa’s healthcare system is to fiscal policy shifts and uncertainty. While the need for increased, sustainable funding – particularly for NHI – is undeniable, the method matters profoundly.

Any potential tax adjustments must be carefully weighed against their impact on the economy, household budgets, and the operational costs within the healthcare sector itself. Most importantly, South Africa needs a clear, consistent, and communicated long-term funding strategy for healthcare. Policy flip-flopping only serves to undermine confidence and delay the urgent task of ensuring quality healthcare access for all. The health of the nation literally depends on getting this right.

What Are Your Thoughts?

The future of healthcare funding affects every South African. Do you think a VAT increase is the right way to fund NHI? What are your concerns about healthcare costs and access?

Share this post and join the conversation. Stay informed, engage with policymakers, and let your voice be heard on this critical issue.

Fudley Bezuidenhout Pr.Eng.

Medinol – Champion Medical Billing Software

Sanlam and Fedhealth Partner to Offer Affordable Healthcare

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By Fedhealth and Sanlam

17 Feb 2025  0

Sanlam has announced an agreement to partner with Fedhealth as their single open medical scheme provider. This move supports the group’s strategy to provide a complete health offering to existing and potential clients as part of its overall financial services value proposition.

The partnership also reinforces Sanlam’s aim to offer an integrated healthcare, insurance and investment offering that delivers more value, affordability, and sustainability.

For Fedhealth, the agreement supports the medical aid provider’s objective of expanding its market share in the corporate market in South Africa which stands to bring in substantial new corporate members via Sanlam’s established client base.

Fedhealth will continue to operate as an independent entity run by a Board of Trustees consisting of scheme members.

Sanlam group CEO, Mr Paul Hanratty said: “We are pleased about the conclusion of our partnership agreement with Fedhealth, which supports our objective to significantly upweight our health focus. Many South Africans need affordable private healthcare delivered by a solid medical aid. Our partnership with Fedhealth demonstrates our commitment to enable accessible healthcare and reinforces our outlook to encourage our clients to live confidently, healthily and resiliently build wealth. We have already migrated most of our staff to Fedhealth and look forward to a mutually beneficial partnership.”

Fedhealth’s Principal Officer, Mr Jeremy Yatt, said the partnership is a synergy of two core shared values: customisation and affordability. “Fedhealth is already unique in the medical aid landscape, thanks to our ability to offer customisable medical aid, which allows our members to craft the plan that suits them, so they do not have to pay for benefits they do not use. This leads to significant cost savings,” he says. “By partnering with Sanlam, we’ll now be able to offer even more money saving opportunities by means of integrated product offerings, an innovative rewards platform and wellness incentives to our members that encourage them to take further charge of their health.”

The partnership is about more than business – it is about making a meaningful difference in the lives of all South Africans. Says Yatt: “By combining Sanlam’s trusted reputation and extensive reach with Fedhealth’s clinical expertise, we are setting a new standard for health and wellness. Together, we aim to bring more benefits, greater access, and cutting-edge innovation to financial, physical, and mental well-being – all in one place. Our vision is clear: to become South Africa’s most trusted health brand by 2030, delivering real value every step of the way.” DM

About Sanlam

The Sanlam group is a leading pan-African financial services group listed on the JSE, Namibian Stock Exchange and A2X Markets Limited. The group provides comprehensive and bespoke financial solutions to institutional clients and consumers across all market segments, including life and general insurance, health, financial planning, retirement, investments, wealth management and credit.

Established in 1918 as a life insurance company, the Sanlam group has evolved into the largest non-banking financial services group in Africa through its diversification strategy achieved through strategic partnerships and acquisitions. Headquartered in South Africa, the Sanlam group operates in 31 countries including eight of the top ten largest economies in Africa.

For more information on Sanlam, visit www.sanlam.com

About Fedhealth

Fedhealth Medical Scheme has been in the healthcare business since 1936, with an unwavering commitment to providing South Africans with quality and affordable medical aid cover.

The Scheme has made it its mission to take excellent care of the changing health and wellness needs of members through innovative product design, whilst always ensuring the sustainability of the Scheme. Run by members for members, and with complete transparency, Fedhealth’s 100% member-elected Board of Trustees operates with one objective only: to put the interests of its members first.

Apart from a successful 88-year track record in healthcare, Fedhealth boasts a Global Credit Rating of AA- retained for 18 consecutive years, and a solvency rate of 31.5% (as at 31 December 2024 – unaudited).

For more information on Fedhealth, visit fedhealth.co.za

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