It’s reassuring belonging to a registered medical aid scheme in South Africa. It means not having to meet an early death from being treated in a State hospital. In the same way, Gap Cover Insurance in South Africa provides peace of mind.
Wonderful though it is to have medical aid, something is missing, which is causing South Africans great stress. There is a gap between what your medical aid pays and what your medical specialists charge.
These medical professionals don’t charge rates that the medical schemes see as fair. They charge well over the medical scheme’s price guidelines. Medical Aids will pay for the amount they consider fair, but they’re not going to pay for the amount that the specialist charges over and beyond these amounts set by the medical scheme.
Without gap cover, you’ll have to pay for these excess amounts.
Details about Gap Cover Insurance in South Africa –
The National Health Reference Price List is a list drawn up by the Department of Health. The medical scheme will pay for treatments within the guidelines of this reference price list. Most medical aid schemes set their scheme tariff at 100% for in-hospital costs. But 100% doesn’t mean your medical bills are paid in full. Hence there is great value in having Gap cover, even for members of medical schemes that pay up to 300% of the scheme rate since the reality is that the specialist charges 3, 4 or 5 times more than the scheme tariff. Further, you should not downgrade your medical aid cover when you get Gap Cover. By downgrading, you may well be sacrificing benefits not related to the in-hospital cover.
Gap cover is provided by insurance companies
Gap cover isn’t medical aid – it’s an insurance product which supplements medical aid. Medical schemes are registered with the Council for Medical Schemes. South Africa has many reputable gap cover providers – Zestlife, Ambledown, Turnberry, Stratum, Xelus – and others. Their products all differ so do get comparative quotes. But, fortunately, gap cover is cheap. Just get a quote on this page to find out.
Gap cover providers all need a short term insurance licence to offer gap cover. Also, you need to be a member of a medical scheme first to get gap cover. It is vital to note that there are waiting periods imposed on gap cover, as well as exclusions. By way of example, Gap insurance does not cover cosmetic surgery or suicidal injuries. Furthermore, you can change medical schemes and still keep the same Gap cover. Also, policyholders don’t have to undergo a medical examination to be eligible for gap cover. Unfortunately, Gap cover does not involve out-of-hospital-costs unless stated otherwise in the policy.
It’s impossible to predict your health care needs in the next weeks or months, and a sudden illness or injury can find you in the hospital when you least expected it. Get gap cover insurance in South Africa – without it, you could be facing frightening financial hardships.
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All info was correct at time of publishing