08/01/2026
Minister seeks to soothe Gems pain
TAMAR KAHN
Business Day
08 Jan 2026
Buthelezi to talk to medical scheme for public servants about ‘unaffordable’ increase
Public service & administration minister Mzamo Buthelezi has told parliament the government will engage with the Government Employees Medical Scheme (Gems) trustees over its “unaffordable tariffs”, which increased 9.8% this year.
While his comments suggest there may be scope for a reduction in members’ monthly contributions, it would be a highly unusual move requiring approval from the industry regulator, the Council for Medical Schemes.
Gems is South Africa’s largest restricted medical scheme and is available only to public servants and their dependants.
Membership is heavily subsidised by the state, which pays up to two-thirds of members’ monthly contributions.
It has come under fire from unions in recent years over its contribution hikes, which increased by a weighted average of 13.4% in 2025 and 9.8% this year.
In August Nehawu, South Africa’s biggest public sector union, urged Gems to hold its 2026 contribution increase to consumer price inflation, which at the time the Reserve Bank projected would be 3.3% this year.
When Gems announced in November that it will be increasing premiums by 9.8%, Nehawu said the scheme is failing to deliver on its mandate to provide affordable medical cover for public servants. The latest increases are higher than those imposed during the height of the Covid-19 pandemic and in its immediate aftermath, when Gems used its accumulated reserves to limit contribution increases to just 2% in 2022 and 5% in 2023.
In line with most medical schemes, Gems experienced unexpectedly low claims during the pandemic as members avoided healthcare facilities for fear of infection and deferred nonurgent care.
In a written response to questions posed by ANC MP Weziwe Tikana-Gxotiwe, Buthelezi said there have been “engagements” with organised labour from the Public Service Co-ordinating Bargaining Council and there are ongoing discussions about minimising the impact of its “unaffordable tariffs”.
“The Gems board of trustees as the authority determining [its] tariffs has already made the decision for the 9.8% increase. However, the employer will engage with the employerappointed trustees to address the impact of the unaffordable tariffs,” he said.
In a separate response to questions put to him by ANC MP Phindisiwe Xaba-Ntshaba, the minister said Gems’ contributions are among the most affordable in South Africa.
“For a typical public service family, contributions are 25% lower than comparable open schemes before subsidies and 67% lower after subsidies.
“This equates to an average monthly saving of approximately R2,029 before subsidy and R4,361 after subsidy,” he said.
Comparable large open schemes, which are available to anyone who can afford their monthly premiums, include Discovery Health Medical Scheme and Bonitas.
Buthelezi said Gems’ board of trustees had prioritised the scheme’s financial sustainability in setting its contribution increases. Failure to do so would result in a decline in the scheme’s reserves and could ultimately result in insolvency, he said.
Gems chief operations officer Vuyo Gqola said there are ongoing engagements between the board of trustees and the minister to ensure the scheme remains financially viable and affordable to members. Annual contribution increases are driven by medical inflation, which consistently far exceeds consumer inflation due to a growing burden of disease, higher utilisation, new technologies and fraud, waste and abuse.
“Without these adjustments, Gems cannot fulfil its mandate to provide access to comprehensive benefits, meet its obligation to pay claims, remain market competitive and [be] financially sustainable, thereby securing long-term access to healthcare for more than 2.4-million beneficiaries,” she said.
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