Top FAQ About Medical Gap Cover in South Africa

Most people don’t know that much about gap cover or how it works. Here is a list of some Gap cover frequently asked questions.

You are missing out on a really great product as a result of not knowing.

Gap cover Frequently asked Questions and Answers

What is Gap Cover? Sometimes your medical bills are higher than what your medical aid plan is prepared to pay. That’s because your medical aid plan will only pay the standard medical aid rate. This could leave a substantial difference that you have to pay. However, with gap cover, they pay the difference.

Gap cover frequently asked questionsAre there Different options Available?

Most gap cover companies offer at least a basic and a comprehensive scheme. Some offer levels of cover in between as well.

More gap cover frequently asked questions Must I apply Through my Medical aid?

Absolutely not. Gap cover is a totally different product – it is short-term insurance. In fact, not all medical aid firms are licensed to sell short-term insurance products. And, even if your medical aid does sell gap cover, it runs independently so it is not linked to your medical aid at all.

Can Anyone Get Gap Cover?

You have to belong to a registered South African medical aid company.

Can gap Cover replace my Medical Aid or Hospital Plan?

Definitely not. In fact, if you are not a member of a medical aid scheme, you will not be able to apply for gap cover or claim from it later. It is a supplement to your healthcare plan, not a replacement.

Gap cover Frequently asked Questions – Does it Cost a Lot?

What surprises most people is that it really does not cost that much. You can get a plan from as little as an R274 a month. Most plans cost somewhere in the region of R30-R350 a month.

Is everything Covered?

No, and that is what helps to keep the premiums more affordable. None of the plans will cover cosmetic surgery of a purely elective nature. Most will pay for the surgery if it is necessary because of an accident or something like cancer.

Dentistry is also not usually covered in the basic policies. Cosmetic dentistry of a purely elective nature will also not be covered. Again, if dentistry is necessary because of an accident or something like cancer, it will be covered.

Can I Boost the Benefits?

Most plans offer add-on extras such as additional dentistry benefits and higher cancer treatment limits. These can usually be added on at a reasonable amount.

What do I Need when I Claim?

You need to provide proof of what the doctors, etc. have charged. Proof of the amount that your medical aid has already settled and you may also be asked for proof by your medical aid that your membership is up to date.

Who does the Claim get Paid to?

In terms of legislation, the money must be paid directly to you. You must then settle the outstanding amount.

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All info was correct at time of publishing