Gap cover is a short-term insurance product. It protects members from the burden of medical shortfall. Gap cover pays the difference between what experts charge and what medical aids pay out. Hence, many members want to know where to get medical gap cover.
There are several options available from various insurers.
Some aid schemes provide gap cover to complement their medical aid plans while other gap cover plans are offered by independent insurers.
Gap Cover Protects Members
It has become vital for people to get gap cover. Because medical aid plans fail to pay the full cost of health bills.
This gap in payment arises because the law does not regulate specialists in South Africa. Experts and private hospitals charge whatever they like. Some experts may even charge five times the suggested amount.
Further, medical aid schemes only pay standard rates. Which means members must then pay a huge portion by themselves.
Where to get Medical Gap Cover
Our favourite gap cover provider is Zestlife. (Get a quote from them on this page just by completing and submitting the short form.
Zestlife Universal Gap Cover enhanced benefits for 2019 include:
- Overall regulatory maximum for medical expense shortfall cover increased from R150 000 to R160 000.
- Cancer lump sum increased from R25 000 to R30 000.
- Casualty benefit increased from R10 000 to R20 000. Casualty visit must be within 48 hours of the accident.
- Medical Aid and Gap Cover Premium Waiver maximum increased from R6 500 toR7 300.
- Medical Aid and Gap Cover Premium Waiver limited to accidental only, but the payment period increased from 3 to 12 months. This change was due to legal requirements.
- Accidental dentistry maximum increased from R15 750 to R19 250 and amount per tooth increased from R2 250 to R2 750.
- Non-Designated Service Provider co-payment increased from R8 600 to R9 300.
- Oncology co-payment maximum increased from 20% to 25%.
- Cover for robotic procedures up to R30 000.
- Cover for procedures in day clinics.
- New Oncology Benefit to cover 20% of treatment cost when oncology limit is exceeded.
- Varicose veins have been added as an out-of-hospital procedure that is covered.
Zestlife Premiums for 2021
Ambledown is another provider
Ambledown also provides gap cover as they are an underwriting agency. They currently have over 150 000 policy holders.
They pay up to 500% of medical tariffs as prescribed in the National Health Price List.
These offers are over and above the Council of Medical Aid’s Prescribed Minimum Benefits that every medical aid scheme should cover as a basic for their members.
Albeit, Ambledown will only pay for their own prescribed doctors and hospitals in a cover of up to R2 million per year.
Ambledown does not require info on pre-existing medical conditions. Further, they have a waiting period of up to twelve months.
Stratum Gap Cover
The Stratum BASE 500 plan offers a comprehensive gap cover plan which pays up to 500% benefit on medical tariffs.
The plan also offers a premium waiver benefit where beneficiaries have their premiums paid up for a certain period after the death of the principal member.
Co-Payments, Oncology Benefit, Sub-Limit, Casualty and Accidental Death, Trauma and Counselling, are some of the key benefits received on this plan.
Where to get Medical Gap Cover; There are several options
There are several other gap cover brokers that one can choose from.
The crucial aspect is that before one signs up, they must carry out proper research on the terms and benefits of each one.
The member should also think about the cost and whether they will be able to afford it.
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All info was correct at time of publishing