Public service & administration minister Mzamo Buthelezi has told parliament the government will engage with the trustees of the Government Employees Medical Scheme (Gems) 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 only available 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 would be increasing premiums by 9.8%, Nehawu said it was 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 non-urgent care.
In a written response to questions posed by ANC MP Weziwe Tikana-Gxotiwe, Buthelezi said there had been “engagements” with organised labour from the Public Service Co-ordinating Bargaining Council and there were 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 employer-appointed trustees to address the impact of the unaffordable tariffs,” he said.
For a typical public service family, contributions are 25% lower than comparable open schemes before subsidies and 67% lower after subsidies.
— Mzamo Buthelezi, public service & administration minister
In a separate response to questions put to him by ANC MP Phindisiwe Xaba-Ntshaba, the minister said Gems’ contributions were 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 recent 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 were ongoing engagements between the board of trustees and the minister to ensure the scheme remained financially viable and affordable to members. Annual contribution increases were driven by medical inflation, which consistently far exceeded consumer price 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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