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GEMS for AI agents

The GEMS connector lets Health Loops agents work with GEMS, a medical scheme in South Africa.

Start free with this agent

Ridgeway LogisticsBenefits agentWhatsApp

Customer: Does my plan cover physio?
Read the plan guide for the member’s optionGEMS
Benefits agent: Your plan guide pays that from your day-to-day benefit, up to its annual limit. From the statement you sent on 3 October, you have about R2,300 left. Want the nearest network options?
Customer: Yes please.
Found 3 nearbyNearby care finder

Sample conversation. People, brands and figures are made up.

What an agent can do with GEMS

Match the member to their GEMS option from the 6 on file (Emerald, Emerald Value, Tanzanite One and 3 more), with their membership number, from a message or a photo of their card
Answer what the member’s option covers from the GEMS plan guide, with the figures for their option and the source shown
Read a claims or benefit statement the member sends and explain each line still owed, in plain words
Find network hospitals, clinics and GPs near the member, then give the GEMS service line to confirm before an admission

Tools.

GEMSLive Discovery HealthLive WhatsAppLive Nearby care finderLive

Country: South Africa
Type: Medical scheme
Options on file (6): Emerald, Emerald Value, Tanzanite One, Ruby, Beryl, Onyx
Service line: 0800 00 4367
Plan guide: Indexed: answers cite the scheme’s own guide

Questions

What can an AI agent do with GEMS?

Match the member to their GEMS option from the 6 on file (Emerald, Emerald Value, Tanzanite One and 3 more), with their membership number, from a message or a photo of their card.

Is the GEMS connector live?

Yes.

Which GEMS options does the agent know?

6 options: Emerald, Emerald Value, Tanzanite One, Ruby, Beryl, Onyx.

Where do answers about GEMS benefits come from?

From the GEMS plan guide for the member’s option, which Ollie indexes and refreshes.

Does the agent decide GEMS claims or authorisations?

No.

Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.