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Purpose. The purpose of this presentation is to provide the Portfolio Committee on Public Service and Administration with an update on GEMS and its performance in the previous year by focusing on:A brief appraisal of the Scheme's background;An overview of the performance in 2009; andAn update on
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1. PORTFOLIO COMMITTEE ON PUBLIC SERVICE AND ADMINISTRATIONGEMS and its performance
2. Purpose The purpose of this presentation is to provide the Portfolio Committee on Public Service and Administration with an update on GEMS and its performance in the previous year by focusing on:
A brief appraisal of the Schemes background;
An overview of the performance in 2009; and
An update on the performance in 2010.
3. Founding Policy Objective The overarching mandate issued by Cabinet in 2004
The state as an employer seeks to ensure that there is adequate provisioning of healthcare coverage to public service employees that is efficient, cost-effective and equitable; and to provide further options for those who wish to purchase more extensive cover
Mandate was informed by entrenched inequity, high costs, absent employer control/influence and limited access to scheme benefits by all employees
4. Policy Steps PSCBC Res 7/2000 provided for restructuring of medical assistance
Feasibility of establishing a Scheme was tested in 2004
Cabinet approved the registration of GEMS in 2004
The Scheme was registered in 2005 and commenced enrolment in 2006
The new Medical Subsidy Policy, after agreement in the PSCBC, was introduced in July 2006
Presidents Coordinating Council resolved that Executive Authorities and HoDs are to promote employee awareness of the subsidy policy
5. Legal Form and Eligibility Restricted membership medical scheme
Full registration under the Medical Schemes Act
Reports to the Registrar of Medical Schemes
Subscribes to Medical Schemes Act 131 of 1998
Establishment provided for in PSCBC Resolution 1/2006
Member eligibility is limited to
National Departments and Provincial Departments & Administrations listed in Schedule 1 and 2 of the Public Service Act
Organisational Components listed in Schedule 3 of the PSAct
Approved employer groups (or related government structures)
NB: SANDF, NIA and SASS have conditions of service which do not allow enrolment on GEMS
6. Corporate Structure Corporate structure consists of:
Board of Trustees (50% elected by members; 50% appointed by the MPSA) that governs the affairs of the Scheme;
PO implements directives of the Board and manages the business; and
Scheme Executive (5) supports PO in monitoring and managing the service levels and contractual obligations of appointed service providers
Efficient scheme head office of 28 team members
Strategic and risk management are owned and managed internally
Operational activities outsourced (over 8 operational contracts)
Resources dedicated to ensuring effective member services
Performance of the scheme is constantly monitored
Locus of control always rests within the Scheme
7. Strategic Thrust Mission Statement
To provide all public service employees with equitable access to affordable and comprehensive healthcare benefits
Vision Statement -
An excellent, sustainable and effective medical scheme for all public service employees
Value Statement -
Excellence Simplicity Clear communication
Member orientation Consistent application
Flexibility Innovative Responsiveness
Value for money Prudence Integrity
8. Member Services
9. Purpose The purpose of this presentation is to provide the Portfolio Committee on Public Service and Administration with an update on GEMS and its performance in the previous year by focusing on:
A brief appraisal of the Schemes background;
An overview of the performance in 2009; and
An update on the performance in 2010.
10. 2009 Business Indicators
11. 2009 Business Indicators
12. 2009 Business Indicators
13. 2009 Business Indicators
14. Achievements in 2009 Rapid growth continued to over 429,000 members
Innovative services were introduced
SMS benefit check and Maternity programme
Over 10,000 healthcare providers registered on Friends of GEMS
Independent member satisfaction survey revealed that over 75% of members have a positive perception of GEMS
2nd GEMS Symposium was held successfully in KZN
Complaints remained low despite the continued growth
Annual Board Effectiveness Appraisal found the Board to be Good
Successful AGM, with record attendance, held in Nelspruit
Record of posting surpluses continued
Audit environment well maintained
4th Annual unqualified audit opinion received
SLAs were maintained and confirmed by way of an audit
Transfer of the business of MEDCOR to GEMS conducted
Fraud Prevention Plan was implemented with the support of the SIU
15. Challenges in 2009 Claims were higher than anticipated
Numerous epidemics
Statutory tariffs increased in 2009 for 2009
Onyx option posted a loss
Reserves at 11,08%
Cost of living increases, numerous OSDs and an adjustment to salary levels were introduced effective 1 July 2009
2009 contribution income bands were proactively adjusted
Over 11% of members were affected and dissatisfaction increased
Income bands will be assessed in 2010 to ensure an even spread
Assisting the Dept. of International Relations and Cooperation with the development of an international benefit option for employees stationed abroad
Council for Medical Schemes instructed GEMS to amend its member eligibility rules to remove the application of discretion by the Board
16. In Summary Significant progress was made
The strategic shift in healthcare management took place
2009 Strategic Plan Progress Report
96% of Indicators met
2009 Three Year Strategic Plan Progress Report
All indicators met
A further level of achievement was evident when reviewing the progress made
GEMS did not receive a qualified audit
GEMS did not experience a cash crisis
GEMS did not experience a service catastrophe
GEMS was not brought into disrepute
17. Purpose The purpose of this presentation is to provide the Portfolio Committee on Public Service and Administration with an update on GEMS and its performance in the previous year by focusing on:
A brief appraisal of the Schemes background;
An overview of the performance in 2009; and
An update on the performance in 2010.
18. 2010 Strategic Plan The 2010 Strategic Plan is informed by:
Performance in 2009;
Consideration of strategic matters that require attention in 2010; and
Appreciation of the capacity and resources to do the approved work.
Sustaining excellence by reviewing the effectiveness of GEMS business, incorporating efficiencies and providing an enabling environment for future success
Initiated strategies must be implemented and practically applied
There is a need to take stock and appraise where GEMS is so as to effectively plan the next three year strategy
This prudent approach will sustain the excellence of GEMS business in an environment that is characterized by extensive change
19. Business Indicators
20. Business Indicators
21. Business Indicators
22. Business Indicators
23. Work Underway Implementing Q2 deliverables in the strategic plan
Implementing approach to member consumerism
Confirming GEMS member eligibility rules
Monitoring the implementation of NHI
Attending to potential changes to the Board
The term of 3 employer appointed and 3 member elected trustees ends in July
Confirming the status of employer appointed Trustees
Implementing the Trustee Election Plan
Managing the Schemes financial performance (and Onyx)
Monitoring the 2010 claims experience against projections
Q1 of 2010 better than Q1 of 2009
Preparing for 2010 audits
Participating in CMS task teams
Participating in MPSA activities
24. Conclusion Business is operating well
Growth is significant
Work is centered on executing the Strategic Plan
Risks have been identified and are being mitigated
Controls are established and well implemented
In a press release issued by the CMS as it turns 10 years old, the CMS states that it smiles at its achievements, such as:
The registration of the Government Employees Medical Scheme (GEMS), contributing to significant growth in the number of medical scheme beneficiaries.
It is proposed that the Portfolio Committee on Public Service and Administration note this update on GEMS and its performance in the previous year