What are the Conflicting Views on Gap Cover for Medical Aid?

In all areas of life, so-called experts differ on their opinions. One expert says dairy is good for you, the other condemns it, and so it is with medical gap cover. Some like Discovery Health think the changes to gap cover will be beneficial. While other experts say the changes will leave lower-income consumers out of pocket. It is no wonder that so many ordinary South African medical aid members question the opinions of so-called experts in the healthcare industry. So what are the conflicting views on gap cover?

Making the Right Gap Cover Choices

When it comes to medical aids and gap cover, extensive research will be required, and if you feel you have exhausted your research, and that there are too many conflicting views,  a reputable financial advisor can help you to make the right gap cover choices. There are different medical gap cover options with different benefits.

The regulatory environment is always changing too and just recently Treasury announced reform to Medical Insurance with ‘Demarcation Regulations. Differentiating between medical schemes and medical insurance products which include gap cover.

Gap cover has become important because of the increasing limitations from medical schemes. Healthcare professionals don’t charge according to the National Health reference price-list and if your medical scheme refuses to pay what they charge, you will have to pay out of your own pocket. It is precisely why gap cover is important

R150 000 Cap on Gap Cover Way Too Little for Some – Conflicting Views on Gap Cover

Conflicting Views on Gap CoverOne of the main changes to gap cover which is causing conflict is the new annual benefit level – it has been capped at R150 000 for each insured person and for each year. When you consider what cancer treatments cost, this is way too little, though others will say it is adequate.

This R150 000 cap applies to members who joined their medical aid after April 2017. The bottom line is that gap cover plans will be able to make payouts to the insured subject to this maximum of R150000 for each person insured. Existing health policies will need to align to the Regulations when renewing their contracts.

Cut Gap Cover and Ultimately Shut-down Medical Schemes

Consumers are currently spending millions on gap cover. Ensuring they aren’t out of pocket when using doctors who charge more than medical scheme rates.

Yes, government’s plan was to cut gap cover, but in cutting gap cover, medical schemes would fold as heaps of people would resign from them because of the exorbitant costs. It is important that consumers stay part of their medical schemes if they are to remain viable.

What is to Become of Gap Cover with NHI? – Conflicting Views on Gap Cover

But now in 2018, once again gap cover will be coming under the spotlight.  Will it exist in the future now that Motsoaledi is looking at the R60bn in medical scheme’s reserves? With so-called affordable health care coming with the NHI, one wonders what will become of medical gap cover, which is a critical add-on to anyone belonging to a medical aid.


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All info was correct at time of publishing