Public sector unions have criticised the Government Employees Medical Scheme (GEMS) for failing to obtain regulatory approval for a reduction in member contributions, questioning whether it had made a strong enough case to the Council for Medical Schemes (CMS).GEMS is South Africa’s biggest medical scheme for state employees with 2.4-million beneficiaries. It has faced intense pressure from organised labour to lower this year’s average contribution increase, initially pegged at 9.8%, over affordability concerns. It obtained approval from the CMS for a slight reduction to 9.5% in April, but on Tuesday the regulator rejected its request to lower the contribution increase still further, to 7.5% in July. The CMS said GEMS’ proposed plan was not in members’ best interests as it put the scheme’s long-term financial stability at risk. Trade union federation Cosatu, which includes South Africa’s biggest unions for teachers, nurses and allied healthcare workers, questioned whether the scheme had presented sufficient evidence to persuade the regulator to approve lower rates.Read: Why medical schemes regulator rejected GEMS’ attempted price cut“We suspect that GEMS hasn’t put up a strong enough case to the CMS because in … everything else that they do, they are proving very mediocre. The only place where they’re not mediocre is in how much they spend (on) themselves,” said Cosatu spokesperson Zanele Sabela.Cosatu has consistently drawn attention to what it considers excessive expenditure on board fees and principal officer remuneration, she said. The trade union federation was also concerned about the scheme’s failure to rein in fraud and its decision to establish its head office in the costly Pretoria suburb of Menlyn, she said. This year’s contribution increase, which followed hard on the heels of an average increase of 13.4% last year, was placing immense financial pressure on public servants. These hikes were much higher than the salary increases won by the employees in the last three-year wage agreement, which saw public servants awarded a pay increase of 5.5% in 2025/26 and inflation-linked increases for the next two years.The Public Servants Association (PSA), the third biggest public sector union, called for full disclosure of the documents GEMS submitted to the CMS motivating for the 7.5% contribution increase. “They must provide us with proof of what they submitted so we can satisfy ourselves that there was an effort made to reduce the subscription to 7.5%,” said PSA GM Reuben Maleka. “We doubt what was submitted, because it’s so unreasonable that the CMS would come to the conclusion that there is no basis for reducing the subscription: do they realise that it means members will have to cancel (membership) because it’s unaffordable?” he said.