Why Should Medical Aid Members Buy Medical Gap Cover?

Buy medical gap coverMany people have been questioning their medical aids recently. They are also wondering why they should buy Medical Gap Cover at all.


Because many people fail to understand how their medical aids function, there is a lot of dissatisfaction regarding payments. The majority of people assume that since the medical aid states that they pay 100% of the scheme rate that they are fully covered. They are often caught off guard by additional medical bills that have to be paid, in spite of the high monthly premiums they paid for medical aid.


Why Buy Medical Gap Cover? Specialist fees are unregulated


One reason to buy medical gap cover is that the specialist fees in South Africa are not regulated. In other words, they are free to set their own rates, often far more than the 100% rate the medical aids cover. The cost can be more than 500% of the scheme rate. Without gap cover, you will be responsible for paying the shortfall.


Let’s use the example of a caesarian section. This reasonably common medical procedure could cost about R12 600 if you are lucky. The medical scheme rate at 100% will mean that the medical aid will pay out about R4 200. You will have to pay the remaining R 8 400 if you do not have gap cover. That is just one example, but it illustrates how important it is.


Medical aid does not cover all of your medical expenses as there is no regulation of the charges levied by hospitals or specialists.

The medical scheme pays their limited portion. Gap Cover pays the outstanding amount into your bank account. And you can settle the remaining bills with those funds.


What are Gap Cover Premiums

Speak to an Experienced Broker


Irrespective of what medical aid you are on or which plan you choose, you will always need additional gap cover.


Unfortunately, the fees charged by specialists go up faster than the medical aid benefits. While it might seem like an extra expense on top of the medical aid premiums, you will be grateful that you took it out.


It makes good sense to study your medical aid benefits and consult an experienced, professional broker to advise you on the benefits of gap cover. It cannot replace your medical aid but enhances and complements it.


Indeed, people often choose to downgrade their medical aid plans without fully understanding the consequences. A broker will be able to assist and advise you.


Gap Cover is Vital


The reality is your medical schemes will not cover all of your medical costs. Not having gap cover will mean that you will be responsible for the shortfalls. Fortunately, gap cover is highly affordable. Those in the field often see shortfalls of R20 000 to R 50 000. If you want to avoid massive debt, gap cover is a wise choice.

To receive a quote for gap cover now. Simply complete and submit the form on this page.




All info was correct at time of publishing