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Govt medical scheme to align benefits with NHI

Nov 10 2018 10:58
Lameez Omarjee, Fin24

The Government Employees Medical Scheme (GEMS) is aligning its benefits with the objectives of the National Health Insurance (NHI) fund to provide primary healthcare access to the vulnerable.

Principle Officer of GEMS Dr Guni Goolab, as well as chief Operations Officer Dr Stan Moloabi, briefed media on the medical schemes offerings for 2019 in Cape Town this week. GEMS is a medical scheme for government employees and was registered on January 1, 2005.

They shared with Fin24 how those offerings would fit with government's policy for universal healthcare access.

Goolab explained to Fin24 that specifically its Emerald value option would address the drive towards affordable primary health care, while its Sapphire option – according to Moloabi – addresses the needs of society's vulnerable.

Minister of Health Dr Aaron Motsoaledi has previously stated at public briefings on NHI that projects for the vulnerable include school health (to address needs of learners), maternal and women's health, mental illness, care for the elderly and care for people with disabilities.

Asked if the efforts to tailor offerings to align with policy would be a waste, seeing as government envisions state medical schemes would fall away once NHI comes into effect, Moloabi said he did not think so.

"Certainly not. Our members need healthcare services today … I don't think it is wasted," he said.

He explained that the scheme operates in line with a regulatory framework and extends benefits in compliance with it – as schemes are subject to the regulator, the Council For Medical Schemes.

"We can't get ahead of ourselves and say – we think policy is going to change in this direction and we will make changes. We wait as policy evolves and legislative changes are introduced and implemented, for us to follow," he explained. When the time comes, the scheme will then keep up with legislation, he said.

"Next year, 2019, [a member] will be living in a world where they can get into a car accident and that member will need access to services and hospitals… We do not see it as a waste, we see it as a necessary change so that we can improve on issues our members have raised at this moment. [The year] 2020 may look different," he said.

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gems  |  guni goolab  |  medical scheme  |  health  |  nhi  |  government
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