Johannesburg – The Government Employees Medical Scheme (GEMS) has announced an average increase of 9.8% for member contributions effective from January next year.
As part of its comprehensive roadmap for 2026, GEMS, which has over 890 000 principal members and more than 2.4 million beneficiaries, announced its “2026 contribution model, confirming an average increase of 9.8% across all benefit options, effective 1 January 2026”.
GEMS stated that for several years, the medical scheme 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,” GEMS said in a statement made available to The Bulrushes.
“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.”
However, the medical scheme said fraudulent and wasteful claims continue to place upward pressure on contributions.
GEMS said it saved its members millions of rand through strengthened fraud prevention and detection systems.
“These efforts will remain central to protecting member value and reducing unnecessary cost pressures,” the statement said.
“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.”
The statement added: “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 said it 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,” said the statement.
“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 said it 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.
“It is important to consider the actual rand value of the increase and the final contribution amount when comparing affordability,” said GEMS Chief Operations Officer Dr. Vuyo Gqola.
“GEMS contributions will continue to be among the most affordable in the sector because of its low starting base.”
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 1 January 2026,” the medical scheme stated.
GEMS said it 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.
The increase is still subject to CMS approval.
