State medical scheme back on track
Tighter controls of hospital admissions and new rules for public servants who hop on and off the scheme pay off, says official
The Government Employees Medical Scheme (Gems) has turned its finances around by tightening control of hospital admissions and introducing new rules for public servants who hop on and off the scheme as their healthcare needs wax and wane, says its principal officer, Gunvant Goolab. Gems, the biggest restricted medical scheme in SA, had 1.833-million beneficiaries at the end of 2016, providing cover to more than half (56.8%) of all eligible public servants. It made headlines in August 2016 when it emerged its solvency ratio was plummeting as it grappled with an unexpected surge in costly hospital admissions. Its solvency ratio plunged from 9.46% in December 2015 to an intrayear low of just under 4% in September before recovering slightly to end the year at 6.99%, according to its 2016 annual report, released on Wednesday. The solvency ratio measures accumulated funds versus annualised contribution income and should be at least 25%, according to the Medical Schemes Act. Gems reported ...
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