The reason it has become essential to take out Gap cover is because your medical aid plan don’t pay hospital bills in full. You pay the outstanding amount.
While it is possible to manage that when it comes to non-urgent treatment, an unexpected illness or accident means finding the money quickly.
And we’re talking about a lot of money, quickly!
The benefits of Medical Gap cover in a Crisis
Even the best medical scheme in the country leaves a shortfall, making many members open to financial crisis. Which is why more and more medical aid members join Gap cover schemes as a safe guard against high costs that result from the shortfall.
What is gap cover and The benefits of Medical Gap cover?
Medical aid firms set the rate for certain procedures. Many of them pay as much as 300% of that rate. However, often specialists charge way over the medical aid rate which creates a shortfall in the payment.
That means where a surgeon may bill you 400% of the rate, your medical aid only pay 300%. You pay the remaining 100%.
Gap cover combines with your medical aid plan. Its main purpose is to cover the difference between their payment and the actual hospital charge. It does not pay for treatment not included by your medical aid. For example, cosmetic surgery.
The benefits of Medical Gap cover – How do I make a claim?
All you need is your hospital bill and medical aid statement. Gap cover pays out once your health care scheme pays their part.
What does It cost?
Premiums are affordable, at R300 to R600 each month per member you get to secure your family’s future medical costs. To get a better understanding of the benefits see the table below.
Gap cover options include:
- Cover for up to 500% of medical aid rates
- Co-payment cover
- Sub-limit cover
- Cancer co-payment cover or oncology benefits
Some companies offering gap cover include Zestlife, Complimed, Liberty, Sanlam, Stratum and Turnberry
Get all the info you can about the different plans before buying. Stay on the lookout for the exact percentage of medical aid rates the gap cover goes up to, and note the exclusions. You want to have as much comprehensive cover as possible, and a set of benefits to go along with it.
Dental benefits, for instance, may cost extra from certain firms. Before making a final decision, you should know that this usually includes only in-hospital treatments.
Benefits of Medical Gap cover – Terms are Vital
Get to know the terms and what the policy covers. Here’s a list of the most important ones:
- Tariff gap: The shortfall between the actual hospital bill related to your procedure and what the medical aid pays.
- Co-payments: Certain treatments need a co-payment. An add-on payment for a list of procedures which are not part of the medical aid cover.
- Sub-limit cover: A limit imposed on the amount payable for certain procedures, set by your medical aid. A sub-limit covers the extra in-hospital treatment.
- Cancer co-payments: Some experimental medication may not be included in your medical aid and a co-payment is required for certain treatment.
Having Gap cover gives you a more stress-free life. No need to wonder about how to pay for an unexpected illness if it’s not fully covered by your medical aid. You can afford it and, all things considered, there are no excuses not to protect your family with the help of Gap cover.
All info was correct at time of publishing