Many people, when deciding whether or not to get gap cover, ask the same question. They want to know why they pay so much to their medical aid but don’t get full payment of bills in return.
Members think their medical aid pays 100% of the costs. Many people only find out about these unexpected costs once they are discharged from a hospital. They discover that the additional costs are something they didn’t anticipate, and can’t afford. Some people stress so much that they end up back in the hospital. Members discover that the additional costs are something they didn’t anticipate and can’t afford.
100% Doesn’t Mean Comprehensive Coverage
There are different medical schemes with different options in South Africa. They come with different benefits. When you do decide on one, you will notice that the professional services from a specialist will cost you anything between 100% to 300% of the medical tariff rates.
Indeed, people think that when it says they are covered 100%, it means precisely that. But Sadly, experts in South Africa are not regulated to what they charge.
They could hospitalise way more than the 100% you thought or what the medical scheme will pay, even up to 500%!. What does this mean? That you as the member of the medical aid scheme must pay the shortfall.
Should you get shortfall insurance?
To begin with, this short-term insurance cover doesn’t form part of your medical aid scheme. Laws that regulate medical Gap Cover are not the same laws that regulate medical aids. The product falls under the short-term insurance Act.
It is really important to consider the importance of having a policy, even for those members of medical aid schemes who do pay 300% of the scheme rate.
A policy refunds you directly by paying money into your bank account. Unlike medical aid schemes that pay the hospital or specialist directly.
It will then be your duty to reimburse your service providers.
Having top-up insurance is not dependent on a particular medical aid scheme. This means you can change your medical aid and still keep your gap cover.
Don’t Downgrade your Medical Aid Plan – Get Gap Cover
Belonging to a medical scheme is expensive in South Africa, so members often think they should downgrade their medical aid and then take out gap cover. They think they will be getting more but paying less.
Don’t believe this. You might well be sacrificing other benefits that are not related to your in-hospital shortfall insurance benefits.
Yes, there is a definite place for this product in the market, and there are many reasons to get it, the biggest one being that you won’t ever have to stress when you start getting medical co-payment expenses.
Who qualifies for gap cover?
If you belong to a medical aid scheme in South Africa, then you can get top-up insurance.
This means the scheme you belong to needs to be registered with the Council for Medical Schemes.
In South Africa, you will find many great cost effective insurance companies that offer gap cover.
You can find a gap cover application forms on this page. Fill it in and send it to get a quote – it’s something you won’t regret.
All info was correct at time of publishing