About Admed Gap Cover
Admed gap cover is a product that will cover shortfalls experienced when you need surgery, specialists or emergency medical treatments and your medical aid fails to cover the full cost.
The plan will also cover you for some specific procedures performed out of the hospital.
There is often a shortfall or gap between the amount charged by surgeons, anaesthetists, GPs and many medical specialists and the amount paid out by medical aids.
Also, if you are on a medical aid, you can complete the form and this page and send it to us for a free quote.
All South African Medical Aid Scheme Members Qualify
Admed Gap Cover from Guard Risk – Do no risk going without it.
The Admed medical gap cover will pay the difference. That is between the amounts charged by the various practitioners and what is paid out by medical aid. However, it does not cover any amount more than five times Admed’s tariff, less the actual amount owing to the medical scheme.
Health Insurance Gap Cover
Anybody that has Medical Aid can take out Admed gap cover. That means that anyone who is a member of a medical aid scheme can benefit. They can take advantage of the shortfall insurance that is provided by Admed gap cover. However, members would only qualify if they were 65 years or younger.
Why Gap Cover is Essential and Urgent
Irrespective of the cost or quality of your hospital cover or medical aid, shortfalls are a relatively common reality. There is often a difference between the actual hospital or medical expenses and what is paid out. That will leave a shortfall or gap that you would have to fund
Although the National Health Reference Price List (NHRPL) exists, medical service providers are free to charge their rates which are often considerably higher.
The difference or shortfall will be for your account, and you will have to find the money to cover these amounts if you do not have gap cover.
Admed Gap Cover will significantly eliminate the risk and financial burden of any extra medical costs.
A Working Example of Gap Cover
All medical aid schemes, from basic hospital plans to comprehensive policies will always have a maximum payout. That can range, depending on the package, from 100% to 150% or sometimes 200% of the in-hospital rates only. The actual expense charged by the medical service providers could be significantly higher than that. It could even be up to 400% of the listed tariffs.
As a subsidiary of Guard Risk Insurance, Admed gap cover will provide for the shortfall between the actual costs of the medical bills for your hospital stay and the amount the medical scheme pays out.
Waiting Periods Apply in particular circumstances
Except for emergency treatment, there is a three-month waiting period from the inception of the plan before you can receive benefits.
For maternity benefits and pre-existing conditions, a 12 month waiting period will apply.
It is essential to familiarise yourself with the specific benefits provided by Admed gap cover. Be sure you have an understanding of the rules. Admed does not cover shortfalls of schemes annual limits and procedure specific co-payments.
For a FREE gap cover quote simply enter your details into the form provided and click the GET A QUOTE button!
All info was correct at time of publishing