Ambledown medical shortfall cover is there to help you over your surprise when your hospital bill arrives.
Costs for private care in South Africa are extremely high and rising steadily as the years’ pass. What may also come as a surprise, however, is you might end up having to pay most of those costs yourself.
There are no surprises with Ambledown medical shortfall cover
That’s where shortfall cover from Ambledown comes in. They will take care of those costs so that you don’t have to.
But what about my Medical aid – won’t they pay?
Medical aid plans are very useful, but you’d be mistaken if you thought you could rely on them fully when it comes to hospitalisation.
There is often a gap between what the medical aid pays and what the doctors and hospitals charge.
Even if your medical aid says that it pays 100% for in-hospital expenses, you would be well advised to check what that means.
What you are likely to find is that “100%” cover applies only to network hospitals and doctors or those charging standard medical aid rates.
How big is the gap?
By now most people realise that they might have to pay a bit extra. However, it’s the size of the shortfall that can come as a shock.
You could end up having to pay two or three times as much as your medical aid does. And when it comes to hospitalisation, we are not talking about small amounts.
What does Ambledown medical shortfall cover have to offer?
Ambledown offers one of the highest annual limits on the market. This is R2 000 000 per family and cover for a maximum of 500% of the standard medical rate.
Hospital fees are excluded, as are extra costs related to medication, materials, and prosthesis. The cover does include medical bills from professionals that result from your stay, for example, physiotherapy.
There is a limit on the amount paid for co-payments for CT and MRI scans. This is R100 000 per family per year. Your cover, should you exceed the sub-limits of your medical aid, is restricted to R50 000 per year for the whole family.
You are limited to using a hospital within the network and must get authorization before admission.
You and your dependents get cover for –
- Certain procedures in the hospital.
- Procedures such as dialysis or chemotherapy if conducted on an out-patient basis.
Points that apply if you have cancer –
- There is a limit of R500 000 for each cycle of treatment.
- Cover for deductibles and co-payments.
- You do have some cover if you exceed the sub-limits of your medical aid.
- Cover for some medication and expenses incurred in a hospital.
- Ambledown will cover cancer treatments as an out-patients.
- They will not cover specialist consultations.
Casualty Cover includes –
- Hospital admission when not covered by the medical aid up to a maximum of R10 000 per year for the whole family.
- The cover is for emergency situations – where it is essential to get medical assistance.
These are the primary benefits for the Ambledown Medical Shortfall Cover. There are numerous other benefits as well. You can also extend your cover by choosing additional cover options.
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All info was correct at time of publishing