MEDICAL AID CLAIMS

GEMS

GEMS doesn't currently have a confirmed benefit for breast pumps, baby monitors or thermometers, they don't appear on GEMS's pre-approved appliance list or their pre-authorisation list. That said, as a registered provider with a practice number, we're happy to help you try! We can put together a pro-forma invoice and the supporting documentation you'd need to check with GEMS directly whether they'll cover your device.

GEMS Coverage

GEMS covers a wide range of medical appliances under its External Medical and Surgical Appliance benefit. Some are pre-approved, and others need pre-authorisation. Breast pumps, baby monitors and thermometers aren't currently included on either list, so we can't guarantee a claim will be approved.

You can check the GEMS Medical Appliances List yourself, or get in touch with GEMS directly to ask what your specific plan allows. Registering for the GEMS Maternity Programme still gives you a dedicated case manager, a Care Plan, and a free maternity bag in your third trimester, regardless of device cover.

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How To Claim

Because there's no confirmed benefit for these devices, we'd recommend getting in touch with us first for a pro-forma invoice and motivation letter so you (or GEMS) can check coverage before you commit to buying. If GEMS confirms cover, shop as normal, add your GEMS details to your cart, pay upfront, and submit the invoice we email you to GEMS for reimbursement.

STEP 1

Check Your Coverage

Check with your scheme to confirm if they will cover the items you want to purchase, and how much coverage is available.

If they need a proforma just get in touch with us and we'll help create one for you.

STEP 2

Order Online & Pay at Checkout

Because we can't submit to your scheme directly, you'll need to pay upfront at checkout. Make sure you include your medical aid details in the cart or add them after checkout.

A few minutes after your order is confirmed and paid, we'll send you an email with your invoice that you can submit to medical aid. The invoice will have our practice number, the products' NAPPI codes, as well as other codes your medical aid would need to process the claim successfully.

STEP 3

Submit Your Claim

Once you receive the invoice, you can submit it directly to your scheme for reimbursement. The medical aid will acknowledge receipt of your claim and will provide you with a reference number.

STEP 4

Reimbursement

Your medical aid will process the claim, and if they approve it, they will reimburse you directly based on your benefits and coverage.

STEP 5

You Receive Your Order

As soon as the order is paid it will be processed by our team to start getting it packed and ready for delivery or collection. Your order may be in your hands before medical aid has processed it.

If you want us to wait until you've got feedback from your medical aid, we absolutely can, just reach out to us and let us know and we'll hold your order until you get feedback.

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If you've got a question, get in touch

Medical aid claims can be confusing, but they don’t have to be. 

If you have any questions, we’re here to help make the process simple, guide you through your options, and help you maximise your available medical aid benefits.

 Get in Touch