Workshop Programme

2. Workshop Programme Part 1: Background Part 2: Benefits and Contributions Part 3: Scheme Operations Part 4: GEMS Features Part 5: Communication Strategy

3. Part 1 - Background

4. Introduction • Questions, rumours, comments • Today: • What is GEMS? • What GEMS offers? • Who can join? • Why should employees join? • What we need from you?

5. Overall Objective “The state, as an employer, seeks to ensure that there is adequate provisioning of healthcare coverage to public service employees that it is efficient, cost-effective and equitable; and to provide further options for those who wish to purchase more extensive cover”

6. Part One - Background

7. Introduction • Questions, rumours, comments • Today: • What is GEMS? • What GEMS offers? • Who can join? • Why should employees join? • What we need from you?

8. Environment • Current subsidy: 2/3rds of contributions to R1014 • 39% of employees (380 000) do not access the subsidy • 550 000 employees do access the subsidy • 44% of covered employees are at the Rand cap • Employees enrolled on 68 medical schemes • Over R5,2 billion per annum • 91% of covered employees on 15 medical schemes • Almost 50% on Bonitas, Polmed and Medshield • High medical inflation • Lack of employer control • Affordability is key

9. Affordability: Coverage by Salary

10. Research Process • 2000 • Define problem and develop outline of possible solutions • 2001 • Investigate the accreditation of a limited number of schemes • 2003 • Investigate the feasibility of a restricted membership medical scheme for public service employees and the option of scheme accreditation • 2004 • Further research on feasibility • Scheme business plan

11. Open Scheme Accreditation • Administrative ease • Single scheme approach even more efficient • Open schemes fee structure: • Broker commissions • Higher administration fees • Absent Employer influence • Product development and costing • No universal coverage attained • Cost implications

12. Mandate and Policy Process • 1999 Remuneration Policy Review • PSCBC Resolution 7 of 2000 • Cabinet approval July 2002 • PSCBC Resolution 2 of 2004 • Cabinet approval 3 November 2004 • Cabinet approval 25 May 2005 • Cabinet approval 14 September 2005

13. GEMS • Registered on 1 January 2005 • Board of Trustees • Principal Officer • Scheme executive • Multiple administrators • Comprehensive managed care • HIV Disease management • Establish operations during 2005 • Active member enrolment 1 January 2006

14. Strategic Focus • Understanding employee needs • Establish competitive scheme • Ensure sustainability • Encourage primary health care • Incorporate innovation • Ensure efficiencies • Eliminate wastage and inefficiencies • Promote BBBEE • Effective information management

15. Member Enrolment • Access • Affordability • Preserve integrity of GEMS benefits and contributions • Critical mass of members and clear time-frames • Social Partners • Valued participation • Alternative options considered: • Income bands • Coverage • Departmental

16. Member Enrolment

17. Member Enrolment • Benefits • Critical mass of members identified • Incremental growth • Operational and financial risk reduced • Mandatory enrolment delayed • Concerns • Reserve transfer • Voluntary enrolment

18. Member Enrolment • Progress • Numerous meetings with labour • Collective bargaining still underway • Draft resolution tabled at PSCBC • Implementation of GEMS is continuing

19. Summary • Interesting programme • Special treats • Great information to be shared • Enjoy

20. Questions?

21. Part Two - Benefits and Contributions

22. 2005 vs. 2006 • Competitiveness • Changes to variable MSA • Changes to treatment of ARB • CMS comments - Ruby option

23. Options 2006

24. Scheme Benefits Sapphire • Lowest cost, basic entry level option for new members • Public hospitals only • PMBs unlimited, other hospital events R100 000 family limit • Out-of-hospital: Basic primary care at PrimeCure network • GP’s, medication, basic dentistry, basic radiology and pathology • Treatment protocols • Chronic meds: PMBs only • No optical benefit • HIV/AIDS benefit programme

25. Scheme Contributions Sapphire

26. Scheme Benefits Beryl • Low cost, entry level option for new members • Network of private hospitals • PMBs unlimited, other hospital events R500 000 family limit • Out-of-hospital: Basic primary care at PrimeCure network • GP’s, medication, basic dentistry, basic radiology and pathology • Treatment protocols • Chronic meds: PMBs only • Optical benefit included • HIV/AIDS benefit programme

27. Beryl Scheme Contributions

28. Scheme Benefits Ruby • Mid-range option for healthy members • All private hospitals • All hospital events unlimited • Out-of-hospital: 25% Personal Savings Account • GP’s, medication, dentistry, radiology and pathology, optical • Free choice of provider • Chronic meds: PMBs only • Comprehensive HIV/AIDS cover

29. Ruby Scheme Contributions

30. Scheme Benefits Emerald • Comprehensive cover for families and chronic members • All private hospitals • All hospital events unlimited • Out-of-hospital cover: • Block benefit limit: R3000 per beneficiary/ R6000 per family • Covers Specialists, basic radiology, pathology & physiotherapy • Individual benefit limits: GPs, dentistry, medicines, scans & optical • Chronic meds: R6000 per beneficiary and R12 000 per family • Comprehensive HIV/AIDS cover

31. Emerald Scheme Contributions

32. Scheme Benefits Onyx • Comprehensive cover with high limits for families and chronic members • All private hospitals • All hospital events unlimited • Out-of-hospital cover: • Block benefit limit: R5000 per beneficiary/ R10 000 per family • Covers Specialists, basic radiology, pathology & physiotherapy • Individual benefit limits: GPs, dentistry, medicines, scans & optical • Chronic meds: R10 000 per beneficiary and R20 000 per family • Comprehensive HIV/AIDS cover

33. Onyx Scheme Contributions

34. Competitiveness of GEMS

35. Part Three - Scheme Operations

36. GEMS Operations • Why GEMS will be a winner • What happens behind the scenes? • Registration process • Claims management • Customer services • What can you expect immediately? • Some fun for today

37. A winning team behind GEMS • GEMS has selected “best of breed” partners to provide services to members: • Metropolitan Health Group – administration • Solutio – managed care services and HIV programme • PrimeCure – primary care and hospital services for two options • We all work together to offer a unique service to GEMS members

38. A winning team behind GEMS • Metropolitan Health Group: • 18 large medical schemes (e.g. Polmed, Bankmed, Transmed) • Interface with Persal for > 150,000 families • Our systems and people rated annually • Etc etc • So, what will we do for you……

39. Questions?

40. Part Four - GEMS Features

41. Why GEMS ? • Government single largest contributor to health spend • Government largest employer • Represent 28% of open scheme membership • Benefits designed specifically for you • 380 000 uncovered – due to affordability • Employees represented in GEMS • Extensive scientific research undertaken • Principles - Equity, Affordability and access to comprehensive cover for all • For you by you

42. The real facts about GEMS • GEMS separately registered legal entity • Governed by Medical Schemes Act • Scheme registered 1 January 2005 • Enrolment of new members starts 1 January 2006 • Supported by Government agencies (Persal,GCIS) • Both private and public hospitals • Scheme - no past legacy • We request your assistance

43. Who may join? • Only public service employees appointed in: • National Departments • Provincial Administrations • Provincial Departments • Organisational Components • Listed in schedules 1, 2, and 3 of the Public Service Act but excluding the SANDF, National Intelligence and South African Secret Service • Fixed term contract employees and other temporary employees appointed for less than 12 months are not eligible • Existing pensioners are eligible

44. Key Differentiators • Easy to understand benefit structures • Competitive rates and benefits • Competitive service fees • Income based rate tables • Entry level and comprehensive options • Both low cost options offer unlimited primary care • Non health care costs of the lowest in Industry • No levies, no co-payments • Includes chronic medicine & other disease and management programmes • GEMS designed just for you

45. Other benefits • Subsidy available for all eligible persons • Comprehensive HIV/Aids program • Individuals free to select level of cover • 5 Options • Automatic acceptance (no special entry criteria) • Traditional healers benefit??????

46. Other features • GEMS actuarially sound • Governance in accordance with best practice • Contributions will be used for member benefits • Improve health of employees • Favourable prospective member profile • Carefully selected service providers • Potential size of GEMS • Positive spin-offs for health sector

47. We need your support • Enormity of the task – impossible without committed support within all structures • Help us by assisting colleagues • Inform colleagues of facts • Sources of Information • Procedures • Forms • We commit to provide the necessary tools • CD’S • Marketing brochure • Posters • Videos • Website • Cassette tapes in various languages

48. GEMS marketing actions • Champions workshop • National & Provincial road shows • Prepare Persal staff and ensure system readiness • Regular communication newsletters, e-mails, website & messages via Persal • Use Human resource staff, communicators, salary and others to promote GEMS

49. Enrolment process • Members responsible to notify existing scheme of cancellation of membership • Members to select appropriate cover • Application and other forms available on website • Register dependants • Complete all required forms: chronic and HIV • Follow HR procedures

50. Where do I obtain more information? • Go to www.gems.gov.za • Call 0860 00GEMS (4367) • E-mail enquiries@gems.gov.za