State employees’ medical scheme faces more legal challenges
Johannesburg - The Government Employees Medical Scheme (Gems) is facing more troubles as public servants are threatening legal action against it for increasing its contributions by 4.25%.
The Public Servants Association (PSA) said it has vigorously canvassed Gems and the Council for Medical Schemes not to effect any increases, taking into account the current economic situation, but its attempts were unsuccessful.
Last month, GEMS announced it would increase contributions for its flagship options, Tanzanite One and Emerald Value, following a decision by its board of directors and approved by the Council for Medical Schemes (CMS), which determines increases.
”The PSA is strongly considering legal action to force Gems/CMS to reconsider the increase in membership fees, especially during a pandemic and the fragile economic climate members are facing,” the union said.
Earlier this month, the Federation of Unions of SA (Fedusa) expressed its disappointment with Gems’ decision to increase the annual membership contribution fees.
Fedusa, of which the PSA is the biggest affiliate, said it disagreed with the decision and called on Gems to implement a moratorium on the increase to bring relief to over-extended public servants. It said the medical scheme was in financially sound position to absorb a fee increase holiday.
The federation demanded that its members not be overburdened with more fee increases and called on Gems to follow other medical aid providers who had frozen increases.
The PSA also wants public servants to be allowed to join other open schemes and for the government to pay the same subsidy as it does to Gems members to enable them to join the scheme of their choice as this would enhance competition and allow workers to choose the most affordable health care provider.
Gems, which has over 1.9 million beneficiaries and 740 000 principal members, defended the contribution increases, saying they were to ensure its long-term financial sustainability and access to quality health care to weather any storm, including Covid-19, in the coming years.
On Tuesday, the CMS released its report on the unfair discrimination and racial profiling of African, Coloured and Indian medical practitioners by medical aid schemes after Gems and the Board of Healthcare Funders failed in their North Gauteng High Court bid to interdict its release.
The report of the investigations panel, chaired by Advocate Tembeka Ngcukaitobi SC found that between 2012 and 2019, Gems, Discovery and Medscheme were more likely to find that black practitioners had committed fraud, waste and abuse of the system than their white counterparts.