All medical aid members need to know how gap cover works.
It is a short-term insurance product that covers the shortfall from medical bills.
Medical gap cover pays for those amounts that the health scheme will not pay for.
How gap Cover works with Your medical Aid plan
Medical aid plans are essential in South Africa as they provide the peace of mind of knowing that one has access to health care.
However, they have fallen short in their ability to pay for health care in full.
Members still find themselves burdened with huge bills. Medical gap cover, therefore, becomes a necessary insurance add-on.
This is just one of many reasons to get gap cover.
Who qualifies for This life-saving Product?
Medical gap cover is available to all South Africans who are 70 years and below and who are on a medical aid scheme with a registered service provider.
Gap cover does not replace your main medical aid. It is an add-on for extra protection While gap cover pays for the medical shortfall, it does not pay for everything.
The benefits of each gap cover will vary by the scheme, with some not paying for certain illnesses such as cancers.
It is, therefore, advisable that members first establish the areas that they will benefit from before signing up with a service provider.
How gap Cover works
Medical aid members pay huge monthly premiums to cover any medical event that may happen. Sadly, they are not fully covered since there is a big gap (shortfall) between what experts charge and what schemes pay out.
Brokers designed gap cover schemes to protect members from paying the shortfall personally.
The law does not regulate specialists, they are free to charge their rates for their service. This will often be five times more than the medical aid plan can pay out in benefits. Members end up having to pay out for the difference from their savings.
The council for medical aid schemes does not govern gap cover. It is an insurance product. Hence, the insurance sector regulates gap cover.
Further, a member may choose to change medical aid schemes, and they can still keep their gap cover.
The claiming Process
Claiming benefits on medical aid gap cover follows the procedures set out by the insurer. However, members can only claim after the medical aid plan has paid their share of the overall bill.
The member has to establish what portion of the bill has been left unpaid and then claim this from their gap cover. The insurer will pay the member directly who then pay their healthcare provider.
If you are still confused about how gap cover works, speak to an insurance broker for more information. Further, there are many gap cover providers to choose from.
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