Gap cover pays out the difference between what your medical aid are prepared to pay and what the specialist charges. So Does gap cover include everything?
To find this out, you need to take a look at your actual policy document.
Are you only covered if you are admitted to a hospital?
Or do you also receive cover for some of the more routine expenses that crop up when you exceed your annual limit?
So does gap cover include everything?
When it comes to hospital expenses, most South Africans are clueless as regards how much they could be on the hook for. Many believe that everything will be paid for by their medical aid.
They learn that they were wrong when they start getting Letters of Demand for an outstanding specialist bill.
And, let’s face it, your medical aid do have a part to play here. They are quick to let you know that you are covered 100% of standard medical aid rates.
What they don’t say is that these standard rates can be a lot lower than the specialist rates.
It is for this reason that you might find that claims are dismissed, even though you have gotten nowhere near the annual limits.
Those in the medical profession tend to feel that the standard rates are inadequate. They thus charge at least double or even more.
So even though your scheme works on a set amount per procedure, there is no guarantee that the doctor treating you will as well. You could end up with a situation where after the medical aid has paid their 100%, you are left with a large unpaid bill.
What happens if your practitioner charges as much as five times the standard rates?
That’s why gap insurance is so critical
Without gap insurance, that means that you pay four times more than the medical aid does towards the bill.
Whether or not it covers everything will depend on the plan that you have taken. Basic plans offer no frills cover and may not include cover for procedures deemed non-essential.
More comprehensive covers may allow you to claim for hospital co-payments and deductibles as well. (As long as these are not as a result of you having not followed your medical scheme’s proper procedures.)
Time for gap cover – but does gap cover include everything?
Gap cover is also an insurance product but one that runs independently of your medical aid. It is not subject to the same amount of regulations that govern your medical aid.
In fact, you’re not even obliged to use the same company for both.
What are the costs involved?
The cover is reasonably inexpensive. A lot of plans will allow you to cover your whole family for a couple of hundred Rands a month. Compare this to the potential for the shortfall on a typical hospital stay and the thousands you might have to pay and it stacks up well.
Gap cover in today’s world is not a nice-to-have, but a must-have. It is peace of mind for your whole family and cheap at the price.
Get a FREE gap cover quote here, just fill out the form on this page and submit it
All info was correct at time of publishing