Benefits Used Available Benefits Used Available

Previous Year Saving

*Day-to-day-limit 242.80 12210.20
03 NICOLE 242.80 5984.20
*Acute Medication 37.70 11166.30
00 EDWARD 6.82 3994.18
03 NICOLE 30.88 3970.12
*Chronic Medication 1325.32 23591.68
00 EDWARD 760.36 11394.64
01 YOLANDE 564.96 11590.04

Statement: 65
Date: 28-01-11

* The above individual limits are subject to the family maximum.

MR EC WATSON
53 FIFE AVENUE
ROWALLAN PARK
6025

IF UNDELIVERED, PLEASE RETURN TO PRIVATE BAG X782 CAPE TOWN 8000

If you have dependant(s) between the ages of
21 and 27 studying full-time this year, please
provide us with proof of registration at a
recognised tertiary institution to ensure their
contributions remain at child rates.
Fax 0861 00 4367 or email enquiries@gems.gov.za.

IMPORTANT CONTACT DETAILS

ADDRESS FOR CORRESPONDENCE CLIENT SERVICE CENTRE
Government Employees Medical Scheme Tel: 0860 00 4367
Private Bag X782 Fax: 0861 00 4367
Cape Town 8000 E-mail: enquiries@gems.gov.za
MANAGED CARE AMBULANCE SERVICES
Hospital Pre-authorisation: 0860 00 4367 0800 44 4367
Chronic Medicine Authorisation: 0860 00 4367
WEBSITES
HIV PROGRAMME - AID FOR AIDS www.gems.gov.za
Tel: 0860 10 0646 www.aidforaids.co.za
Fax: 0800 60 0773
E-mail: afa@gems.gov.za
 GEMS Member: 000645581 Reference: A1729314383 Date: 28-01-11 Statement: 65 Page: 2
Transaction Information Payment Information Additional Benefit Information *=Reversal

Date Tariff Amount Benefit Scheme Scheme Member Member See Amount paid Amount paid Tax claimable
Patient from In Hospi- from other
Treated Code Claimed Approved Paid Supplier Paid Member Owes Scheme Owes Supplier Below Amount
tal benefit limits
MEDIPOST PHARMACY 6065732 (Chemist)
28/01/11 Member Chrnic 136.30 136.30 136.30 136.30
28/01/11 Member Chrnic 243.37 170.36 170.36 73.01 278 170.36 73.01
28/01/11 Member Chrnic 73.52 73.52 73.52 73.52
28/01/11 YOLANDE Chrnic 178.37 178.37 178.37 178.37
28/01/11 YOLANDE Chrnic 58.42 58.42 58.42 58.42
28/01/11 YOLANDE Chrnic 45.69 45.69 45.69 45.69
MARE W J MRS 8406758 (Dietician)
13/01/11 NICOLE 84200 30.60 227
Summary of codes
227 Correct tariff codes required
278 Balance payable by member

Totals 766.27 662.66 662.66 73.01 662.66 73.01

Summary of Financial Information

Payable to member (Credit) 0.00
Less owed to Scheme (Debit) 0.00
Member to pay Supplier/s 73.01

Tax claimable to date 861.02