If you are a member of Selfmed Medical Scheme, you may already have heard of gap insurance for Selfmed clients.
Perhaps you even considered taking it out but decided that it was an unnecessary expense. After all, everyone has had to start tightening their belts lately.
But have you heard the saying, “Pennywise and pound foolish”? Well, there is no better example of how this saying applies to real life than with gap cover.
Sure, by not taking it out, you are saving yourself around R200 per month. And, if you have a medical aid plan, you might not feel that you need the extra cover. Anyway, your medical aid will pay your full hospital bills.
That may have been true in the past, but things have changed a lot in the last decade or so.
What is Gap Insurance for Selfmed customers?
The gap, in this case, refers to the difference between what your medical aid will pay and what your doctor charges.
Medical aid no longer pays whatever the doctor/hospital charges. They have a set rate of tariffs that relate to what they think medical treatment should cost. Anything that is over that amount you have to pay.
You might already have come up against this problem with your regular GP visits. And with a GP, it’s not that much of an issue. After all, maybe they charge another R100 or R200 over and above what the medical aid standard rate. It’s affordable.
Now imagine that same principle, multiplied by a few thousand Rand, and you begin to understand why gap cover is important.
If you are in an accident or need emergency surgery, you’re going to need the care of specialist surgeons and doctors. And they are going to charge a lot more than what your medical aid will pay.
You could end up having to pay very expensive bills, even though your medical aid pays their agreed amount. And with hospitalisation, this can quickly reach exorbitant totals.
So, unless you have a plan in place, you might need to look into selling a kidney so that you can afford to get the care you need.
Bridging the Gap
Gap cover is an inexpensive solution to the problem. Gap cover will pay the amount that your medical plan does not cover.
Most gap cover companies still use your medical aid’s base rates to determine what they will pay. They, however, work on much higher limits. Some gap cover companies offer to cover up to 5 times standard medical aid rates.
They only pay out if your medical aid has paid a portion of the bill. And you must be a member of a medical scheme to qualify for gap cover in the first place.
Gap Insurance for Selfmed is not a replacement for your medical aid plan, but an enhancement to it. It runs separately and you can take it out from an entirely different company to your medical aid plan if you want.
If you belong to a medical aid plan, get your gap cover quote now
All info was correct at time of publishing