There are many different kinds of gap cover in South Africa because medical aid plans do not always cover their members’ health care bills in full.
Gap cover is crucial. as members should not have to pay extra fees just because of their medical aid plan shortcoming.
There are Many different Kinds of gap Cover in South Africa
Health experts charge as much as they want for procedures. The law does not regulate them. With that in mind, medical aid companies have had a torrid time trying to budget for specialised medical treatment, as they find that no two practitioners will charge the same for the same procedure.
The National Health Reference Price List sets up guidelines with regards to how much experts should charge. But the law does not force them to follow these guidelines. Further, medical aids only pay out according to the NHRPL guidelines. Which means there is a great difference between what experts charge and what aids pay. It is then the members who pay the difference, which could add up to thousands of Rands.
The Council for Medical Schemes regulates normal health aids. But since Gap cover is a short-term insurance scheme, it follows the Short Term Insurance Act. When a consumer sets out to select gap cover, they have to ensure that they get a product that caters to their needs. Thus, it is vital that they research the various options before settling for one.
Different kinds of Gap Cover in South Africa
There are many different kinds of gap cover on offer in SA. The major gap cover providers in South Africa are Liberty, Sanlam, Complimed, Stratum and Turnberry. Each of these insurers’ products’is unique to the company’s terms and conditions.
Complimed has a two product bouquet where the LPE Enhancer [Listed Procedure Enhancer], which is a fee discounted cover, only available to consumers who are already on the Discovery Health medical aid plan ‘KeyCare’. All other clients who wish to get gap cover from Complimed will have to get the ‘Gap Supreme’ package.
The Liberty ‘ZestLife’ gap cover is sufficient to cover the policyholder, an unlimited number of children and spouse even if they have a different medical aid cover. The gap cover also covers elderly dependants including parents and older siblings at no extra cost to the policyholder. Liberty designed their gap cover scheme to pay all costs not covered by the primary medical aid.
The Sanlam Gap Cover is in two product forms that are Standard Gap and Comprehensive Gap cover schemes, and both offer in-hospital procedure covers. Stratum, on the other hand, offers five products; each designed to meet a certain shortfall the medical aid would not cover. Turnberry offers one gap cover product which also covers for in-hospital treatment.
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All info was correct at time of publishing