The Government Employees Medical Scheme (GEMS) processes roughly R180m in claims and 22 000 GP visits per day, and has paid out in just a single year what one of the country’s largest private medical aids has distributed over a quarter of a century, reports The Citizen. GEMS said it was beginning to experience a shortfall in funds available for claims, having dipped into its reserves to the tune of R10bn, and with its reserves dropping below the statutory requirement at the end of last year. It added that a “delicate balance must be struck between financial sustainability and affordability”, that it needed to institute “cost containment” measures to safeguard affordability. Among its top 10 claimants, one member received a R11.4m payout, with the next nine ranging between R7.4m and R3.8m. The circumstances of the payouts were not explained but the department confirmed they were the equivalent of the members’ total contributions. As a result of the staggeringly high claim volumes, GEMS members have now been hit with an increase in premiums from 1 April, after lengthy negotiations with unions that settled on an increase. Monthly payments for members increased by 13.4% in 2025, with unions and management agreeing on a 9.5% increase for 2026 – although the Federation of Unions of South Africa (Fedusa) complained that public servants had been given only a 4% salary increase for the coming financial year. GEMS’s four tiers range from between around R1 700 per month to just under R5 000. Well used Data recently released by the Department of Public Service and Administration show that GEMS beneficiaries, who number slightly more than 2.3m, make significantly more regular use of their plans than some other medical aids. In a written parliamentary response, the department said GEMS paid out R67bn in claims, despite only collecting R65bn in contributions. The department registers roughly 100 new beneficiaries and 450 dependents per day. Beneficiaries average 22 000 general practitioner consultations daily, 60 births, as well as just under 600 hospital visits per day. It pays out around R180m per day in claims, as well as R27m in specialist claims daily. Paid to stay healthy Earlier in March, Discovery released performance data on payouts and benefits for its roughly 3.9m members. It paid R11.5bn in claims in 2025, with the numbers showing that claims in recent years were exponentially higher than less than a decade ago. It said it had paid more than R67bn over the past 25 years. Notably, R36bn of this was paid in the past five years alone, more than the total paid in the previous 20 years combined.” Cancer was the main driver of claims, with 45% of serious illness claims due to the disease. “Cancer remains a significant driver of claims, but early detection is rising,” the JSE-listed company stated. Additionally, it paid out R1.25bn to members who stayed healthy via its Vitality programme, as well as R1.16bn via a retirement benefit linked to their life cover plan. The Citizen article – Government medical aid pays out six times more than the largest private scheme (Open access) See more from MedicalBrief archives: Unions step up threats over GEMS increases GEMS given seven days to respond to union demands on steep hikes State medical aid premiums now unaffordable, claims PSA
GEMS takes financial strain as member claims rocket
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