Quick Answer: How do I submit a claim to gems?

How do I claim money back from Gems medical aid?

Call us on 0860 00 4367. When you have paid a healthcare service provider for a service, you may claim a refund from the Scheme. Whether we pay the claim, and how much we pay, will be determined by the Scheme Rules.

How long does gems take to refund?

Once processed, refunds to your bank account can take up to five business days to show on your account. We can process a refund for any amount if we have your bank account details on file, and we have used the bank account details more than 30 days ago.

Does GEMS pay for plastic surgery?

GEMS does not pay for)

All costs for operations, medicines, treatments and procedures for cosmetic purposes (cosmetic refers to treatments or procedures that do not treat an illness), such as liposuction. Visits to specialists outside of the GEMS Network for Sapphire and Beryl beneficiaries.

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Does GEMS pay for Gynaecologist?

The Specialist Network provides you with access to Physicians, Paediatricians, Obstetricians and Gynaecologists at a set tariff for both in- and out-of-hospital ensuring that you will not be liable for a co-payment (subject to your option’s benefit limits). …

How do I apply for medical aid gems?

For more information on how to join GEMS, please visit www.gems.gov.za, or call 0860 00 4367, or SMS “please call me” to 083 450 4367 and an agent will call you. Take Note: Adult dependant rates are payable for all eligible dependants who are 21 years of age or older.

How can I get my gems statement?

To obtain your tax certificate from GEMS, contact our call centre’s 24-hour automated self-service facility on 0860-00-4367, or log on to Member Online on www.gems.gov.za.

Is there a waiting period for GEMS medical aid?

There are two types of GEMS waiting periods: A general waiting period (GWP) of up to 3 months. A condition-specific waiting period (CSWP) of up to 12 months.

How do I send proof of registration to GEMS?

documents, you can submit it for registration in any of the following ways:

  1. Fax: 0861 00 4367; or.
  2. Email: enquiries@gems.gov.za; or.
  3. Post: GEMS at Private Bag X782, Cape Town 8000; or.
  4. Walk-in Centres: drop it off at any of the following GEMS Walk-in Centres:
  5. Eastern Cape.
  6. Gauteng.
  7. KwaZulu-Natal.
  8. Limpopo.

Does GEMS pay for blood pressure machine?

**********: Apply for Authorization and Approval to buy a Blood Pressure M.T. Machine. … GEMS pre-approval and authorization is needed to buy this mentioned ITEM and that GEMS will undertake to pay the cost of it in full as promised by your officials.

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How do I register for gems maternity program?

Registering on the programme

You need to complete an enrolment form and fax, email or post the completed form to 0861 00 4367, enquiries@gems.gov.za or GEMS Maternity Programme, Private Bag X782, Cape Town, 8000.

Does gems Beryl pay for braces?

The benefit for orthodontic treatment is only available to GEMS beneficiaries under the age of 21 on the Ruby, Emerald, Emerald Value and Onyx options. This is a once in a lifetime benefit.

Does GEMS pay for gastroscopy?

Gastroscopy, Colonoscopy, Cataract surgery will require and be subject to pre-authorisation. Sigmoidoscopy, Proctoscopy, Vasectomy, flexible Nasopharyngolaryngoscopy and ingrown toenail procedures performed in doctor’s rooms reimbursed at 200% of the GEMS Scheme Rate do not require pre-authorisation.

Does GEMS pay for a Covid test?

“GEMS members will be serviced and should not be requested to pay for COVID-19 testing upfront. The testing of members where guidelines are not met is not considered as PMB level of care as it is regarded as not clinically appropriate.

Does GEMS cover a dentist?

GEMS has designed the dental benefit to ensure that members have access to cost-effective, quality dental healthcare. It is important for you to have regular dental check-ups. What if I need dental treatment under general anaesthetic?

Does GEMS have a hospital plan?

GEMS Hospital Plan – Access to Affordable Health Care

Their aim is to provide all employees in the public service with access to affordable health care benefits.