More about the Emerald Value option
You must nominate a GP, who must be a part of the GEMS network, as your first-line of consultation when you seek medical care.
A 30% co-payment applies on all GP claims received from a non-nominated GP.
You must choose a hospital from the Emerald Value hospital network for your in-hospital needs.
If you visit a non-network hospital (i.e. not included in our network hospitals on the Emerald Value Option) you have to make a co-payment of up to R12 000.
This co-payment will be waived in cases of a medical emergency, but once the patient has been stabilised, the Scheme may require that the patient be transferred to a network hospital.
Members and dependants are still required to obtain authorisation to be admitted to a network hospital.
If you’re admitted into a network facility and the authorisation is not obtained (as per the Scheme rules), a late authorisation penalty of R 1 000 will be applied.
Specialist referrals must be obtained from your nominated GP for all specialist treatments and consultations.
We’ve made a provision to give our members the medical care they require if they’re travelling or need specialised care that isn’t available through their nominated healthcare providers.
As part of this provision, members are allocated three visits to a non-nominated GP per family (annually) for emergencies only i.e. cases where you can’t get access to your nominated GP.
Please note: Access to this benefit is not automatic. You need to contact us by calling our call centre on 0860 00 4367 or sending an email to firstname.lastname@example.org to ensure that you don’t incur a 30% co-payment for such visits.
|Salary band||Principal Member||Additional adult member||Additional child member|
|0 - R14650||R2434||R1859||R905|
|R14650.01 - R25301||R2694||R2087||R1015|
Use the QR Code to download the GEMS Member App. Or get it from Google play or App Store.