For several years, GEMS deliberately used its reserves to shield members from steep contribution increases, resulting in more than R10 billion in direct savings. This approach consistently kept contributions well below the rate of healthcare inflation, even as utilisation and treatment costs rose across the industry. With reserves now stabilising at regulatory minimum levels, the Scheme must responsibly realign contributions to safeguard its ability to pay claims and ensure long-term sustainability.
Fraudulent and wasteful claims continue to place upward pressure on contributions. GEMS saved its members millions through strengthened fraud prevention and detection systems. These efforts will remain central to protecting member value and reducing unnecessary cost pressures.
With a significant jump from fifth to second place, GEMS was recently recognised as the second-ranked medical aid in the Ask Afrika Orange Index 2025, a leading South African customer experience benchmark. This independent acknowledgement reflects the Scheme’s ongoing focus on member experience and value.
While contribution increases are never easy, the 2026 adjustment has been carefully calibrated to remain as low as possible while ensuring the Scheme can continue to pay claims and provide quality healthcare to more than 2.4 million beneficiaries.”
Beyond keeping contributions among the lowest in the industry, GEMS continues to offer benefits that many other schemes have only recently introduced. For example, the Scheme’s Extender Benefit for Emerald and Emerald Value Option members, which provides additional day-to-day medical cover once members reach their benefit limits, has been in place for years, well ahead of similar offerings by competitors.
As a restricted, not-for-profit medical scheme created specifically for public service employees, GEMS operates with no shareholders and returns all surpluses to member value. Its administrative efficiency, with non-healthcare costs nearly half that of comparable open schemes, ensures that more of every rand contributed goes directly toward healthcare.
GEMS also provides income-tiered benefit options to ensure affordability across salary bands, supported by government subsidies that make private healthcare more accessible for lower-income public servants. In addition, the Scheme’s fraud prevention and detection framework, recognised by the Council for Medical Schemes (CMS), protects member funds and promotes fairness in claims management.
These differentiators reinforce GEMS’s founding purpose, which is to provide equitable, affordable and high-quality healthcare designed around the realities of South Africa’s public servants.
The increase will take effect on January 01, 2026. GEMS will provide members with personalised contribution tables, educational material and call-centre support to help them understand what the adjustment means for their household budget. It should also be noted that the increase is still subject to CMS approval.
GEMS remains deeply committed to its founding mandate and its role as a strategic health partner to the public service. The GEMS Roadmap for 2026 is an unwavering declaration that we will continue to innovate and strategically manage resources to ensure the Scheme’s financial and clinical sustainability. The Scheme’s goal is to make world-class, quality-driven healthcare both accessible and a catalyst for the overall health and economic security of all public service employees, qualifying employer groups and their families across South Africa.