Trade unions in the Public Service Co-ordinating Bargaining Council (PSCBC) have rejected the decision by the Government Employees Medical Scheme (Gems) to implement a 9.8% membership contribution increase from January, followed by a revised 9.5% increase from April 1.
They said these contribution increases were economically unjustifiable, socially regressive and inconsistent with the founding mandate of Gems.
The unions include the Public Servants Association, the Health and Other Service Personnel Trade Union of South Africa and the South African Policing Union.
“This decision comes at a time when public servants continue to face sustained financial pressure due to rising living costs, increased household debt and stagnant real wage growth.”
The unions said the cumulative effect threatened access to affordable health care and had direct implications for worker wellbeing and the sustainability of public service delivery.
Gems was established through PSCBC Resolution 1 of 2006 as a social solidarity medical scheme and was never intended to operate as a commercial enterprise, they said.
Gems’ mandate was to expand access to health care, particularly for lower- and middle-income public servants, to provide affordable, sustainable and cost-effective medical cover and to promote equity, risk pooling and social solidarity within the public service.
“The repeated imposition of above-inflation contribution increases reflects a sustained departure from this mandate.”
They said instead of strengthening affordability and solidarity, the scheme has shifted financial pressures onto members.
The unions said Gems implemented a 13.4% contribution increase in 2025.
“The 9.8% increase from January 2026, followed by the 9.5% adjustment effective April 1 results in a cumulative increase of 23.2% over two years.
The unions said public servants received a 5.5% salary increase for 2025/26 and would receive a 4% salary increase for 2026/2027, effective April 2026. Inflation remained at about 3.5% in late 2025.
“The mismatch between wage adjustments and medical aid contribution increases is clear. Real income is being eroded. Workers are being forced to choose between health care and other basic necessities.”
According to the unions, the Council for Medical Schemes proposed an average membership contribution increase of 3.3% for 2026 was reasonable. The membership increases by Gems “significantly exceeds the regulator’s benchmark”, they said.
The unions remained deeply concerned about governance and operational deficiencies at Gems, including: weak accountability and insufficient consequence management, continued outsourcing of administrative functions nearly two decades after the establishment of the scheme, and high administrative costs reflected in annual reporting.
They said they were also concerned about executive and board remuneration practices misaligned with public service norms and limited transparency regarding operational budgets and line items.
“Instead of addressing these structural cost drivers, members are being required to absorb escalating increases.”
They also said there had been no meaningful restructuring of benefit options to strengthen affordability for lower-income public servants.
“Risk pooling and cross-subsidisation mechanisms have not been sufficiently enhanced. The consequence is that some members downgrade benefits or exit the scheme entirely.”
The unions demanded the immediate withdrawal of the 9.8% increase from January and the 9.5% adjustment from April 1.
They also demanded a forensic audit into governance, finances, procurement practices and administrative expenditure.
“Organised labour in the PSCBC will embark on a co-ordinated programme of action, including a march and demonstration to the Gems head office on February 21 and engagements with the ministers responsible for public service and administration, health and finance.”
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