Stricter controls to protect our members and remain a sustainable medical scheme

Since our launch in 2006, we have prided ourselves on being able to provide all public service employees with equitable access to affordable and comprehensive healthcare benefits. To ensure that our members and their families have access to the healthcare they need, we undertook to:

• Provide full cover, without any waiting periods, for people who join with chronic or life-threatening conditions.
• Not penalise people who never had medical cover before.
• Allow your parents, grandparents, in-laws and nieces and nephews to join GEMS if they are financially dependent on you.

While these measures were introduced to assist members to provide healthcare cover to their families, through the years we have noticed an increasing number of members have taken advantage of these measures through anti-selective behaviour.

What is anti-selective behaviour?

• Members who only join the Scheme when they need expensive medical treatment, and resign from the Scheme soon after
  receiving the required care or procedure.
• Members who add dependants only when they require medical interventions and resigning those dependants soon
  after the required procedure or care has been received.
• Members who belong to other schemes, and only join GEMS on retirement.

This behaviour affects not only the sustainability of the Scheme, but also directly affects your pocket. Members who behave in
this way access funds at the expense of other members who have contributed over a much longer period. This reduces the funds we keep in reserve for future healthcare needs of members and affects the rest of the membership as they have to pay higher contributions in subsequent years to replace the lost funds.

To protect the Scheme and you, our members, the Board has decided to apply some controls (also known as underwriting). These controls are in the form of waiting periods and will be applied as follows with effect from 1 October 2016:

These are measures we are compelled to take to limit exposure to anti-selection, fraud, waste and abuse within the Scheme, and ultimately to protect your interests and the Scheme's sustainability.

We will be setting up Lekgotla roadshows across the Public Service to engage with members on the changes and how these will affect you. Mental disorders are high among people living with HIV/AIDS with major depressive disorder (MDD) occurring almost twice as often among this group than among the general population. Mental disorders may increase an individual's risk , of HIV infection through increased social vulnerability, altered risk behaviour, associated substance misuse and loss of control in sexual relationships.