Have you heard of “top up cover” or “gap cover”? In this article, we explain about Genesis medical aid members and gap cover.
There is some confusion about what it is and why is it necessary. The confusion around gap cover usually centres on “Do I need this type of cover?”
Most people who have medical aid may also get a hospital plan and consider gap cover just an extra expense.
Why Genesis Medical Aid gap Cover?
“I already have a medical aid plan” is the most common reasons people have for not considering gap cover.
The problem comes in when making a hospital claim. If the total amount is much more than what Genesis believes the medical tariffs, you have to pay the excess.
These are rates that Genesis itself has determined what it can afford to pay per procedure.
Medical aid payments come from a pool of funds that monthly premiums generate. If they paid everyone’s hospital claims out in full, no matter what amount they were, they would soon run out of funds.
As a result, they carefully calculate what income they believe they have available, and what the average cost of procedure has been. The total does not always tally with what your bill states.
Also, they have limits and sub-limits on the cover itself. Now, these may seem quite high until you find yourself in need of specialist care. As a consequence, your cover may fall short.
Closing the Insurance Gap
If you want to complete your overall medical cover, gap insurance becomes essential. Gap or “top up” cover is there for the times when your health plan aid falls short.
Gap cover usually refers to treatment in a hospital, but some out-patient treatment might also be covered. As a Genesis member, you can choose whichever gap cover provider you like.
Qualifying for Cover with Genesis Medical Aid
It’s simple to qualify for cover. As long as you are a member of Genesis Medical Aid and your payments are up to date, you can apply. Some gap cover companies do impose a maximum age limit of 60, but this is not a typical requirement, though.
Exclusions
If you have a pre-diagnosed condition, you can still get cover. However, you won’t be able to claim benefits related to this condition for the first year.
Most policies will not cover hospitalisation for elective surgery that is not for health reasons. In most cases, dentistry and cosmetic surgery claims are only considered if they are the result of injury or serious disease.
Injuries that are self-inflicted or attempts at suicide are excluded.
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