Covering the Gap Between Medical Bills and Medical Aid Payments

South African medical aid members are looking for new ways of covering the gap between health bills and what their medical aids are willing to pay.

The National Health Reference Price List (NHRPL) recommends rates that experts should charge for medical service. This is the standard by which medical aid schemes calculate their payment schedules.

Sadly, there are no laws about medical fees in South Africa. Which means that health experts are free to set their prices as high as they like.

Covering the GapNew data shows that some private hospitals and experts are charging more than 300% of the NHRPL tariffs. Far above what any scheme will pay for treatment.

Which means that it is the members who must foot the bill for the gap and pay these extra amounts.

Gap Cover Policies Cover the Gap

Luckily for consumers, many of SA’s best medical cover providers offer gap cover policies. To bridge the gap between bills and payments. And saving their clients a fortune when it comes to health costs.

Let’s take a look at what some of South Africa’s major insurers are offering.

Covering the Gap with Complimed

Complimed is helping to cover the gap with a choice of quality gap cover products.

Depending on your needs, you can opt for Gap Cover, Gap Select, Gap Plus Senior or Gap Supreme.

Another one of Complimed’s expert products is the Listed Procedure Enhancer. Which is a low-premium policy made to provide cover for certain procedures.

Covering the Gap with Liberty

Liberty Health’s Zestlife gap cover another popular medical shortfall option.

Zestlife offers not only to cover the gap when it comes to shortfall payments. But also boasts a range of optional protection, including an oncology benefit, dental cover and a medical premium waiver package. In this way, Zestlife tailors the policy to a client’s special needs.

Liberty is known for their no-questions-asked policy when it comes to the application for cover. Also, no age-limit applies to Zestlife membership. Another great feature is the provision for both partners to be covered by the policy, even if they are not on the same medical aid schemes.

Covering the Gap with Stratum

Stratum Benefits also offer a range of gap cover products designed to suit all budgets and needs.

Stratum’s BASE500 is their introduction-level policy and offers to pay up to 500% of MST rates for medical treatment.

Other options from Stratum include the Co-Evolution policy, which makes provisions for co-payments. And the Elite plan, which offers the useful Sub-Limit benefit among other things.

Covering the Gap with Sanlam

Sanlam offers either their Standard Gap Cover or their more widespread Comprehensive Gap Cover. Both of which include a range of in-hospital as well as out-of-hospital benefits. With low monthly premiums, Sanlam’s gap cover products offer great value for money and added protection for any existing medical aid policy.

Cover the Gap

With so many options available, consumers are sure to find at least one policy well suited to their needs. Contact an expert and see how a gap cover policy can help to cover extra medical bills.

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All info was correct at time of publishing