As a member of Sizwe, Gap Insurance for Sizwe Medical Aid clients could come in very handy. This is an excellent medical aid, but it may not be sufficient cover for a hospital stay.
Good medical care in South Africa costs a good deal of money. The better the care you receive, the more it costs, and if you thought that your medical aid would cover the entire bill for a hospital stay, you would be sadly mistaken.
Medical aid plans only pay so much for treatment – they do not have limitless funds. You could easily run into a situation where even if your medical aid pays 100% of their portion, you still have to pay in for any shortfall.
A lot of South Africans don’t realise that their medical aid only pays a portion of the bill. Luckily, you are reading this and getting a better understanding of how things work.
Gap Insurance for Sizwe Medical aid and Standard medical Tariffs
Your medical aid needs to determine how much it can afford to pay for each procedure. They want to be able to provide cover for all their clients.
They set out the tariffs that they will pay. Typically that means that they pay 100% of the Standard Medical Tariff (SMT) when processing a hospital claim.
You’d think that this was all that is required. However, if specialist treatment was involved, this won’t cover the final amount.
Medical professionals can set their rate to whatever they like. This rate is seldom in line with the SMT. In fact, it is often a lot higher. You might end up having to pay out more than your medical aid did. Some of these fees can be as much as 4 or 5 times what the SMT is.
Gap insurance for Sizwe Medical Aid and You
If you are on the Full Budget Plan from Sizwe, you can opt to take out gap cover as well. This cover will pay out the difference for you.
This cover runs separately from your regular medical plan. You must submit claims separately.
Must I Pay First?
Sizwe does not ask its members to pay fees in advance. You must, however, apply for authorisation for your stay before being admitted to hospital.
What if I am Not on the Full Budget Plan?
This is the only plan that allows members to take gap cover through Sizwe. You can, however, take gap cover out from a different company if you like.
My Budget is Very Tight at the Moment
It is because your budget is tight that you need to take out gap cover. Hospital stays are an extremely expensive business. And a medical emergency can happen in a heartbeat.
If you end up in a hospital today for an emergency procedure, how much extra cash can you find? Can you afford to rack up thousands of Rand in unpaid hospital bills? If the answer is, “No”, you need to consider taking out gap cover.
If you belong to a registered medical aid plan, fill in the form on this page and get your gap cover quote now
