Is the medical gap cover controversy over?
- Yes, till the debate continues with the start of National Health Insurance.
- The industry has agreed upon a gap cover limit of R150,000 per person.
- This cap on medical gap cover applies to those policies written after April.
- The demarcation regulations have made it that those over 60 can invest in gap cover but at a higher premium.
- There are many gap cover providers – some offer gap cover to all medical aid which some are selective.
A Re-Look at Gap Cover when NHI Arrives – Is the Medical Gap Cover Controversy Over
Medical insurance, as well as gap cover in South Africa, has always been a controversial topic. Resulting in the National Treasury stepping in to protect the consumers. And this is where the Demarcation Act comes in. Medical insurance products sometimes fail to meet their legal requirements, and this is why they introduced the Demarcation Regulations.
The idea is to see that Medical Aid and Medical Insurance is clearly demarcated. The National Treasury gave the latest version of the Demarcation Regulations for implementation in April 2017.
With gap cover, you shouldn’t assume all costs will be covered. This is because gap cover is subject to limits and exclusions. Policyholders need to make certain what has coverage. With the introduction of NHI, will gap cover even exist then seeing that medical cover is going to be so affordable for all?
You also need to remember that Gap Cover is an insurance product and the companies that sell them are ‘for profit’ organisations. Medical aid, on the other hand, is ‘not for profit’. Medical gap cover is aligned with the same underwriting requirements by medical schemes, such as waiting periods for various specified conditions.
An Attempt to Scrap Medical Gap Cover
Gap cover has always been a controversial- as well as a contentious issue. There was a time when the Council for Medical Schemes took on one of South Africa’s leading financial services groups in an effort to stop it from offering gap insurance products. A2008 draft amendment to the Medical Schemes Act was withdrawn to allow for more focus on National Health Insurance instead.
In 2018 gap cover still remains, being available to complement medical aids, providing additional protection against health-related risks.
Gap Cover No Longer Unlimited – Is the Medical Gap Cover Controversy Over
Gap cover differs from policy to policy in terms of their offerings. As well as exclusions and waiting periods, but now, with the new regulations, the benefits are no longer unlimited but are now capped at R150,000 for each insured person for each year.
The question still rages on as to why gap cover is such an important part of medical aid expenditure. A Guardrisk spokesperson says that in 2015 the average gap cover claim rose 38% and the number of claims also increased hugely.
Contributing to these hikes is the medical aid. They are raising their premiums dramatically each year while at the same time reducing their benefits.
Gap Cover – the Key for Some Surgeons Going Ahead with Treatment
The truth with gap cover is that there are doctors who are charging way more than medical scheme tariffs. And this is because they know that their patients have gap cover and there is certainty they will get money. Because of this you even get doctors who first ask patients whether they have gap cover or not and adjust their invoices accordingly.
Unfortunately, this increased awareness of gap cover has simply made some medical aid scheme member claim more against their policies.
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