December 2014 Dear GEMS member Nominate your preferred GEMS Network Family Practitioner (FP) The Family Practitioner (commonly known as a General Practitioner or GP) plays a vital role in providing you with quality healthcare. To help your Family Practitioner (FP) keep track of your healthcare, it is important that you consult the same FP for all your healthcare needs. Consulting the same FP helps him or her develop a good understanding of your health and treatment history so that they can make informed decisions about your care, such as determining if you need to be referred to a Specialist. This means you will receive the best possible health care from the right person, with the right skills and knowledge about your history and have better control over how your benefits are being managed. It is because of these benefits that GEMS is requiring you and your dependants to nominate a GEMS network FP before 01 April 2015. We believe that this will help you and your family receive the best care and realise the benefits of using one provider. 1.

Why do I need to have a nominated Family Practitioner (FP)?

By consulting the same FP you will help to ensure that:  your doctor develops a good understanding of your health and treatment history so that they can make informed decisions about your health  no duplicate diagnostic tests are done –this will help to preserve your benefits  hospital admissions and re-admissions are reduced 2.

How do I select or change my nominated Family Practitioner (FP)?

To assist you with the process of FP nomination, GEMS will automatically allocate you and your dependants a GEMS Network doctor that you currently visit. You and your dependants will receive communication confirming which Network FP has been allocated to you. If GEMS could not allocate you a network FP, you will receive communication informing you of this and requesting that you inform us who your nominated FP should be. If you would like to change the allocated FP or if you were not allocated a FP, please phone the GEMS Call Centre before 01 April 2015. If you visit a FP that is not your nominated GEMS FP after 01 April 2015, your claim may not be paid in full (refer to section 4 below). After 01 April 2015, your nominated FP can be changed only once every six (6) months. The information below will assist you in selecting or changing your nominated FP:  Sapphire and Beryl (SB) members must select a FP from the SB FP Network and Ruby, Emerald and Onyx (REO) members must select a FP from the REO FP Network.  To find a FP on the GEMS SB or REO FP Networks, go to www.gems.gov.za (click on ‘GEMS Network’ under ‘Members’) or contact the GEMS Call Centre on 0860 00 4367.  Adult dependants (e.g. spouses) can select their own FP different from the main member’s FP. If a child dependent is below sixteen (16) years of age, then a nominated FP will be selected by the registered Main Member of the Scheme.

 Please ensure that you have an FP selected before 01 April 2015 or your consultation may not be paid in full (refer to section 4 below).  Once your nominated FP is selected, you will receive an SMS confirming this. .  After 01 April 2015, the nominated FP can be changed only once every six (6) months 3.

What happens if my current Family Practitioner is not on the GEMS network?

The Family Practitioner you choose to nominate will need to be on the GEMS Network in 2015. If your current FP is not on the GEMS Network, GEMS will actively assist you to get your FP on the Network before 1 April 2015. Should your FP choose not to join the GEMS Network, you will be notified and given the option to select a network FP of your choice. 4.

What happens if my nominated Family Practitioner (FP) is NOT available?

If you are on holiday or out-of-town and need to see an FP, the consultation will be paid from your ‘non-nominated’ benefit. This benefit allows three visits per family to a FP who is not your nominated FP. If your ‘non-nominated’ benefit is depleted and you visit a non-nominated FP, then:  GEMS Ruby, Emerald and Onyx members will have a 30% co-payment on their account, provided they still have benefits available.  GEMS Sapphire and Beryl accounts for non-nominated FP will not be paid by the Scheme after the 3 visits allowed under the non-nominated FP benefit are exhausted. Please ensure that you only see your nominated FP to avoid out-of-pocket-payments. 5.

May I have more than one nominated Family Practitioner (FP)?

GEMS supports co-ordination of care, which is why it is important to have one nominated FP. However, the following exceptional circumstances will permit you to have an additional nominated FP: For child dependants: Children who live for an extended period in two or more households that are far from each other, such as:  When parents are divorced or separated and the child lives at both locations.  When a child attends school away from home e.g. at boarding school or tertiary institution  When a child is in foster care, or living with extended family member(s). Note: this will not apply if the households the child lives in are in the same location or if the locations are in close proximity to one another. For main members and adult dependants:  Where a person’s work is of such a nature that he / she is situated at different locations for a period longer than three (3) months at a time. If you have any queries about nominating a Network FP or need more information about nominating an additional FP, please contact the GEMS Call Centre on 0860 00 4367 or send an email to [email protected] . Kind regards, GEMS Network Management