Medical Gap Cover – More About How Much Gap Cover Covers

Does Medical Gap Insurance Cover include Everything?

Gap insurance is designed to pay for the difference that arises between what hospitals and doctors charge and what your primary medical cover pays. However, does gap cover pay for everything that your health plan does not pay? Depending on the policy subscribed to, it can cover the rest of your medical bill. Alternatively, it can pay for daily expenses below your annual upper limit.

That is because occasionally, you will find a bill or two that your primary cover declines to pay. You may be unaware that you do not have comprehensive cover until you make a claim.

It’s a common mistaken belief that your health insurance will cater for your entire medical bill in the event you have an emergency that requires immediate attention.

The medical plan will not provide for your specialist’s procedures. When they do, they will often put a limit on the amount they will cover. Ordinarily, they set these restrictions as the standard medical rates.

gap insurance cover

What Does Gap Insurance Cover?

When you have yearly upper limits about hospitalisation, the medical scheme will require you to pay for any shortfall that may arise. The majority of medical consultants, charge way more than the standard tariffs set by set by health schemes. Thus, medical covers will only pay the agreed amount leaving you to pay for the excess.

The medical plans follow pre-established medical rates, but doctors are not obliged to follow the stipulated standards.

As crazy as it may sound, you health cover will pay 100% of the prescribed tariffs. However, the practitioner may charge anywhere between 200% and 500% of the standard rates.

Besides, in most of the cases, demand for the medical services dictates the prices. Because of this, the prices fluctuate in either the client’s favour or for the doctors.

That’s Where Gap Insurance Cover Comes in

Gap plan has nothing to do with your health insurance plan and does not have to play by the same rules. Thus, you do not have to take your Gap cover with the same company that provides your basic health insurance.

In most cases, Gap tends to be way much affordable than the majority of the medical insurance plans with premiums going for as low as R200 per month. Besides, considering that the shortfall amount might amount to thousand of Rand, this is not bad. Does gap cover cater for everything? If yes, you should take comprehensive gap cover.

What will Gap Cover Actually Cover?

In addition to gap plan covering for a shortfall, they also cater for medical cover shortfalls.

However, dependent on the gap cover you take, gap cover could also be covering you for co-payments or deposits relating to hospitalisation, co-payments, as a result of not using the chosen provider and co-payments as a result of costs that exceed your limits.

Does Gap Cover pay the Bills?

Gap cover directly pays the policyholder, and then the gap cover requires you to pay the bills yourself. The main disparity between this claim and the one sent to your medical cover is that for this one you have to prove how much the health cover paid out.

We highly recommend Zestlife for Gap cover in South Africa.

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All info was correct at time of publishing