GEMS unveils 2026 Roadmap and announces 9.8% contribution increase

The Government Employees Medical Scheme (GEMS), South Africa’s largest restricted medical scheme, has unveiled its Roadmap for 2026, outlining a strategic plan to strengthen long-term sustainability, enhance member benefits and improve efficiency across the healthcare value chain.

As part of the announcement, GEMS has confirmed an average 9.8% contribution adjustment across all benefit options, effective 1 January 2026, pending approval from the Council for Medical Schemes (CMS).

GEMS is the largest restricted membership medical scheme in South Africa, with over 890 000 principal members and more than 2.4 million beneficiaries. 

The medical scheme, which has maintained 18 consecutive years of clean audits, said the contribution adjustment is a necessary investment to secure access, value and stability for its more than 2.4 million beneficiaries.

GEMS chief operations officer, Dr Vuyo Gqola cautioned that focusing solely on percentage increases can distort affordability comparisons.

“It is important to consider the actual Rand value of the increase and the final contribution amount when comparing affordability. GEMS contributions will continue to be among the most affordable in the sector because of its low starting base,” Gqola said.

For a standard public service family, GEMS said contributions remain up to 23% lower than comparable open schemes before subsidies are applied.

For several years, GEMS intentionally drew down its reserves to shield members from steep contribution hikes, delivering more than R10 billion in direct savings.

This helped keep contribution increases well below healthcare inflation, even as utilisation patterns rose sharply across the industry. With reserves now stabilising at regulatory minimum levels, the scheme says realigning contributions is essential to ensuring its continued ability to pay claims.

However, fraudulent and wasteful claims remain a pressure point. But GEMS said enhanced fraud detection systems have already saved members millions, and the scheme will continue strengthening these safeguards.

Reflecting growing member confidence, GEMS moved from fifth to second place in the Ask Afrika Orange Index 2025, one of South Africa’s leading customer experience benchmarks. The scheme said this independent recognition confirms its continued focus on delivering value and service excellence.

GEMS highlighted that, despite keeping contributions among the lowest in the industry, it continues to offer benefits that many open schemes have only recently introduced.

For example, the long-standing Extender Benefit for Emerald and Emerald Value Option members provides additional day-to-day cover once limits are reached, a feature introduced years before similar benefits emerged in the broader market.

As a restricted, not-for-profit medical scheme for public service employees, GEMS has no shareholders, and all surpluses are reinvested into member value.

Its non-healthcare costs remain almost half that of comparable open schemes, enabling more of each rand contributed to flow directly into healthcare benefits.

GEMS also offers income-tiered benefit options to support affordability across salary bands. Government subsidies further enhance access to private healthcare for lower-income public servants.

The scheme’s fraud prevention framework, recognised by the CMS, continues to protect member funds and uphold fairness in claims management.

The 2026 contribution adjustment will take effect on 1 January 2026, with personalised contribution tables, educational material and call-centre support to be provided to help members understand the impact on their budgets.

GEMS said the newly launched Roadmap for 2026 reflects its unwavering commitment to financial sustainability, clinical excellence and its founding purpose.

“We will continue to innovate and strategically manage resources to ensure that GEMS remains a catalyst for quality healthcare, economic security and improved well-being for public service employees and their families,” the scheme said.

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