How Does a Medical Gap Policy Work?

Many South African do not know how a gap plan can help them. So, how does a medical gap policy work?

Gap cover can prove invaluable for South African medical aid members.

It bridges the gap between the price your medical aid is willing to pay and what the specialist charges you.

By purchasing gap insurance, you protect yourself from having to pay for the shortfall, which can run into thousands of Rands.

How does a Medical gap Policy work with My medical aid Plan?

How does a medical gap policy work?One advantage of buying medical gap cover is that you can pay your premiums like your medical aid premiums – in monthly instalments.

In South Africa, having a medical aid can give you peace of mind. But people are becoming angry and stressed because their medical aid plans aren’t paying the full bill.

They don’t Fully take Care of your Needs

They aren’t taking care of the in-hospital medical expenses of their members. So apart from paying high medical aid premiums each month, members have to also personally pay many of their medical bills.

Buying medical gap cover is the only solution, and at least the monthly premiums are small. Medical gap cover is for anyone who is a member of a registered medical scheme.

Most gap cover providers want you to buy gap cover before you turn 60 or 65 years of age. There are however instances where you can be older than 70 or even 80 years of age.

How does a Medical gap Policy work?

  • Don’t just assume that with gap cover, they cover everything. There are some cancers, for instance, which most gap cover policies don’t cover. However, they will review each case
  • Your day-to-day medical requirements aren’t covered by gap cover
  • Buying gap cover doesn’t require you to have a medical examination
  • Gap cover isn’t a medical aid plan, but rather a supplement to your medical scheme.
  • The laws which govern medical schemes don’t govern gap cover. Medical schemes are regulated by the Council for Medical Schemes while gap cover is short-term insurance
  • Your claim is made apart from your medical scheme. You submit your claim for gap cover after your medical aid has paid the doctor or hospital
  • Depending on the service provider and the benefits you choose, with gap cover, you could pay anything between R80 and R400 a month for the whole family.

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All info was correct at time of publishing