The Government Employees’ Medical Scheme has denied rumours it is buckling under financial strain.
Civil organisations, doctors and members have complained their claims have not been paid, sparking fears about the financial state of the scheme, known as Gems.
Individual members and at least one labour union yesterday told the Daily Dispatch of issues with the scheme, which has around 700000 members and 1.8million beneficiaries.
In addition a Facebook page called Away with Gems is filled with complaints from members across the country, all accusing the scheme of failing to settle medical bills.
Members claim they have had to pay the accounts themselves to avoid legal action.
Gems yesterday downplayed the complaints, saying it had “technical problems” in implementing a new payment system but it was not in financial straits.
Spokeswoman Liziwe Nkonyana said “more than 95%” of claims had been paid normally.
“At the beginning of January Gems appointed a new national service provider to handle claims for medicines, pathology and radiology services,” she said.
“As a result there were technical problems with some payments following the implementation of this new arrangement.”
Apologising for the problems, Nkonyana said: “We wish to assure our valued service providers and members this matter is receiving our very best attention.”
Democratic Nursing Organisation of South Africa’s (Denosa) acting provincial secretary Khaya Sodidi confirmed they had received complaints from members over Gems.
“There have been a number of complaints from members about depleted funds while some were receiving letters from lawyers demanding payments to medical institutions,” said Sodidi.
“We had to get involved to try and give advice and solve the problem.”
He said many Denosa members had resigned from the scheme.
“But we are sure everything will be solved as the Gems principal administrator has promised.”
Members who spoke anonymously to the Dispatch yesterday said Gems was even failing to pay for blood tests, forcing members to fork out hundreds of rands – sometimes thousands – from their own pockets.
A department of social development and special programmes employee said members in the past had been able to get any over-the-counter medicine using Gems.
“But today you can hardly get vitamins or immune boosters,” said the member.
An education department employee said they were now limited when buying over-the-counter medicine.
“We are not even allowed to buy medicine worth more than R200 a day,” said the employee.
But Nkonyana said scheme rules with regards to over-the-counter funds were tightened “as some members were misusing scheme funds to buy non-medical, luxury items. Such funds are now capped,” she said. — bonganif@dispatch.co.za
Health aid scheme claims unpaid
Civil organisations, doctors and members have complained their claims have not been paid, sparking fears about the financial state of the scheme, known as Gems.
Individual members and at least one labour union yesterday told the Daily Dispatch of issues with the scheme, which has around 700000 members and 1.8million beneficiaries.
In addition a Facebook page called Away with Gems is filled with complaints from members across the country, all accusing the scheme of failing to settle medical bills.
Members claim they have had to pay the accounts themselves to avoid legal action.
Gems yesterday downplayed the complaints, saying it had “technical problems” in implementing a new payment system but it was not in financial straits.
Spokeswoman Liziwe Nkonyana said “more than 95%” of claims had been paid normally.
“At the beginning of January Gems appointed a new national service provider to handle claims for medicines, pathology and radiology services,” she said.
“As a result there were technical problems with some payments following the implementation of this new arrangement.”
Apologising for the problems, Nkonyana said: “We wish to assure our valued service providers and members this matter is receiving our very best attention.”
Democratic Nursing Organisation of South Africa’s (Denosa) acting provincial secretary Khaya Sodidi confirmed they had received complaints from members over Gems.
“There have been a number of complaints from members about depleted funds while some were receiving letters from lawyers demanding payments to medical institutions,” said Sodidi.
“We had to get involved to try and give advice and solve the problem.”
He said many Denosa members had resigned from the scheme.
“But we are sure everything will be solved as the Gems principal administrator has promised.”
Members who spoke anonymously to the Dispatch yesterday said Gems was even failing to pay for blood tests, forcing members to fork out hundreds of rands – sometimes thousands – from their own pockets.
A department of social development and special programmes employee said members in the past had been able to get any over-the-counter medicine using Gems.
“But today you can hardly get vitamins or immune boosters,” said the member.
An education department employee said they were now limited when buying over-the-counter medicine.
“We are not even allowed to buy medicine worth more than R200 a day,” said the employee.
But Nkonyana said scheme rules with regards to over-the-counter funds were tightened “as some members were misusing scheme funds to buy non-medical, luxury items. Such funds are now capped,” she said. — bonganif@dispatch.co.za
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