GEMS pays out 91m claims amounting to R29.1bn in 2017
The Government Employees Medical Scheme (GEMS) paid out 91m claims for its 1.8m-strong membership base during 2017, amounting to a total value of more than R29.1bn.
According to Dr Guni Goolab, principal officer of GEMS, the claims included 5.6m family practitioner consultations, 440,738 hospital admissions and close on a million medical specialist consultations. There were 24,538 babies delivered, 87,348 specialist consultations for pregnancy supervision, 13,162 cataract procedures, and over 45m medicines among the 91m claim lines covered.
“Not only did the scheme pay claims exceeding R29bn, which represents a significant amount of healthcare expenditure, but we have also worked hard to make sure these funds stretch further through the validation of claims and agreements with our network of healthcare providers,” Goolab said.
Placing an emphasis on the role of primary healthcare and preventative care, and the introduction of measures such as care coordination has allowed the scheme to take good care of members’ day-to-day health needs while ensuring benefits are available should they require hospitalisation or specialists’ services.
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