RV
Ruan V

1 reviews | Active since Aug 2013

30 Oct 2025, 11:17

Terribly unrealistic benefits.

I am on the Emerald plan(Second best). How is it possible that GP-visits, physio, Specialist visits, pathology and histology, psychology and psychiatry, occupational therapy, chiropractic and basic radiology are subject to Day-to-day benefit of R6173. This is not at all realistic. How is this amount calculated? Are they even aware of what these claims cost? Every year after barely any claims my benefits are depleted and I then have to pay everything myself?? Year after year. Minimal claims and then the rest of the year I can’t claim anything. So when a person is ill, he can’t go to the doctor, can’t visit psychiatrist or psychologist if he is suicidal, can’t visit specialists or have procedures done, no radiology. This is *******. I pay a lot of money every month, but the claims paid don’t even add up to that. You are failing the government employed people.

0
Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply30 Oct 2025, 12:09
Official
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RV
Ruan V's update01 Dec 2025, 15:23
Reviewer Update
Now the following issue…My wife needs to het her contraceptive, for which there is a benefit of R1118.46 left, but contraceptive is apparently connected to Acute benefit?? How is it possible that all the benefits are connected to some other benefit?? Absolute nonsense. The benefits you can see on your app/website clearly means nothing. This is fast becoming the worst medical aid in South Africa. They have all sorts of excuses not to pay for medical care, but the monthly instalment increases with a ridiculous amount in January 2026. Far exceeding our yearly raise. So now my wife can’t even het her contraceptive. If she gets pregnant, this is on you GEMS!