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 Gemsto 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”.
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“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.
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. 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.
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