Investing in medical Gap coverage is an important step in being financially prepared during medical emergencies. Gap cover is not a medical scheme. It is an insurance that falls under Short-term insurance that will help you bridge shortfall. Most members of medical aid in South Africa are using state health or private health care providers and yearly pay huge amounts of money out of their wallets. So How does medical gap cover work?
In-hospital treatment is very expensive. Specialists, anaesthetists, doctors, surgeons and other professional medical care providers have the freedom to charge the rate they choose.
These professionals will bill you separately. The shortfall is the difference between the cost charged by your medical provider in-hospital and the amount your medical scheme will pay.
How does medical gap cover work – Options
Medical schemes in South Africa offer a variety of options from which you can choose, and these options differ in the benefits offered, and premiums.
If your medical aid covers 100% of the bill, your specialist’ tariff can be up to 500% more. It will lead to an immense 400% that you will have to pay out of your wallet. The South African government do not regulate the fees charged by specialists, and that is the reason why they can charge a tariff they choose. Most South Africans are under the impression that if they have a medical scheme, that it will pay their medical expenses in full. Unfortunately, in most cases, the medical schemes will not cover the full tariff charged. Gap cover is to assist you in times of need.
Without Gap cover, you will have to pay the shortfall, and that can add up to thousands of serious incidents.
It will be advisable to familiarise yourself with the conditions and requirements before investing in Gap Coverage.
It is required to be an active member of a medical scheme before you can apply for Gap Cover. And the good news is that you don’t need to be a member of a specific medical aid provider to get gap benefits. Gap benefits are to compliment your existing Medical scheme.
How does medical gap cover work – Applying
Age, existing conditions, pregnancy, cosmetic surgery, etc, go into consideration when you apply for Gap Cover.
There is usually a waiting period before you can submit a claim.
So your medical aid reimburses your provider. Gap cover providers refund the members directly into their bank accounts. The member is liable to pay his or her service provider.
Gap Cover will give you peace of mind. When medical emergencies strike, you can focus on getting the best medical treatment, knowing you are prepared for the bills.
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All info was correct at time of publishing