The Government Employees Medical Scheme (Gems) has defended its decision to increase member contributions in 2026, saying the hikes are necessary to keep the scheme financially stable and able to meet the healthcare needs of public service workers.
Teacher union SAOU this week slammed the hikes, saying they were imposed unilaterally and were unaffordable.
Gems said the contribution adjustments are driven by medical inflation, which continues to outpace CPI due to increasing healthcare use, new technologies, a growing disease burden and fraud, waste and abuse in the sector.
“Without these adjustments, Gems cannot fulfil its promise to members to maintain a comprehensive basket of benefits, meet its obligation to pay claims, remain market-competitive and financially sustainable,” said COO Vuyo Gqola.
The scheme rejected claims that the increases were imposed without engagement, insisting it followed its established consultative process with unions represented in the Public Service Co-ordinating Bargaining Council (PSCBC).
“Gems confirms engagements with PSCBC representatives on the 2026 contribution increase of 9.8% took place.”
All contribution increases are approved by its board of trustees and then submitted to the Council for Medical Schemes for regulatory review, and the 2026 increases are still subject to approval.
Gqola said Gems has for years used its financial reserves to protect members from even larger increases, generating more than R10bn in direct savings. But reserves have now stabilised at minimum regulatory levels. “The scheme must responsibly realign contributions to safeguard its ability to pay claims and ensure long-term sustainability.”
Gems said it remains one of the most affordable medical schemes in the country, and contributions for a standard public service family are up to 23% lower compared with open schemes before the employer subsidy and up to 51% lower afterwards.
Contributions are determined by salary band, family size and the plan a member chooses.
Higher-income earners on entry-level options such as Tanzanite One and Beryl will experience higher percentage increases due to their higher salary level.
Responding to criticism about dissatisfaction, Gems pointed to its performance in the Ask Afrika Orange Index, saying it is recognised as one of the best medical aids for customer experience.
Gems highlighted its governance record, saying it has maintained 18 consecutive clean financial audits, which it says is proof of strict financial management and long-term stability. The scheme services more than 2.4-million beneficiaries.
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