What is Medical Gap Cover?

Many medical aid policyholders in South Africa will tell you that their medical aid funds don’t last the year. Thus it is vital to know about gap cover. So what is Medical Gap Cover? It is an add-on to your medical aid that pays the difference between what experts charge and what your scheme pays out.

A Supplement to Medical Aid

Why get medical gap cover, and what is it exactly? We will try to answer these questions as quickly as possible. Medical aid costs are rising while benefits are getting less. It’s what has made the product become so sought after. To understand what medical gap cover is, you need to know that the product isn’t part of your medical aid, but rather a supplement to it.

What is medical gap coverThis insurance product is governed by the rules of the Short-term Insurance Act. Thankfully top-up insurance doesn’t only work for those on certain medical aids. Everybody, regardless of the registered medical scheme they belong to, can get a policy.

Unregulated Specialists Charge what they Like so Get Gap Cover

Gap cover is a critical supplement to medical aid in South Africa. After your medical aid has paid the service provider according to their internal tariff rates, there’s going to be an excess amount that has to be settled. This excess amount comes about because unregulated specialists will charge you far over the  tariff rate. Your medical scheme believes this is too much, so they’re not going to pay it.

A policy doesn’t cost a lot – not anything close to what you pay for your medical aid each month. The costs of gap cover vary a lot, depending on the cover you take, but premiums can start at R80 a month per family and increase to roughly R400 a month per family.

There are waiting periods with the product as well as exclusions to every type of gap cover you invest in. Some of these exclusions include –

  • Suicide attempts and self-inflicted injuries
  • Cosmetic surgery
  • Drug abuse
  • Military- or police duty
  • Some mental illnesses such as depression and dementia

When you do research, you’ll find that different policies offer different maximum entry ages. Most gap cover providers don’t take people beyond the age of 65, but there are others that have no maximum entry age.

The truth is, medical aids have built in limits. Unless you’re on one of the absolute best medical schemes in South Africa,  they’re not going to be paying all your medical bills, and this is why you need medical gap cover.

Medical Gap Cover for Medical Scheme Members

What is Medical Gap Cover exactly?

The product is short term insurance that takes care of the expenses your medical aid doesn’t pay. Before you check out any policy, first do research and find out what the cover entails. There are many plans on the market today, such as Stratum, Ambledown, Zestlife, Xelus and Complimed, so it is important to do research and choose the right one.

Patients are at risk with in-hospital treatments, and shortfalls of R30k are common. Without gap cover, there are very few South Africans who can haul out sums like this and settle their medical bills.

Given scenarios like this, it’s obvious that shortfall insurance is stepping in where medical aids aren’t, and the many benefits that gap cover offers help South Africans enjoy greater peace of mind.

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All info was correct at time of publishing