Medical shortfall insurance has become popular because members have found themselves burdened with huge bills. This is why medical gap cover is important.
Client’s who have loyally paid their health scheme premiums, expecting to receive full medical cover, have had to pay huge bills.
This has made for a very maddening situation; where members are the ones who remain disappointed at the rate of delivery of medical aid schemes.
Health Schemes are Not Enough
Aid schemes have continued to increase their premium rates; making the cost of being on a medical aid plan enormous.
Yet, they still expect members to dig deeper and pay the shortfall that arises from experts charging more than medical aids can pay.
This is because the law does not regulate health care in South Africa. As such medical experts and private hospitals will charge what they feel is fair value.
This is usually up to five times more than what medical aids can pay for. As stated before, this is why medical gap cover is important.
How does the product work?
Gap cover is not a medical aid. It is an add-on policy that protects members against extra costs.
Therefore medical gap cover will not pay for the general day-to-day visits to a medical expert.
Gap cover will pay for the more serious health emergencies that require hospitalisation, surgery and other specialised treatments and care.
Gap cover only pays for the shortfall after the medical aid has paid their portion.
And unlike medical aid, gap cover pays the principal who then pays the service provider.
Gap cover has become a popular option because it safeguards members from having to search elsewhere for funds to cover the gap left by their medical aid.
Medical aids only pay benefits by the Council of Medical Aid’s Prescribed Minimum Benefits policy. Because of this policy, gap cover has proved vital in paying for treatments of major illnesses such as cancer.
This is why shortfall insurance is vital
Gap cover gives members the courage to proceed with their healthcare from an institution of their choice. Without being forced to get care from the state hospital because the medical plan cannot afford them their choice.
Members have fast realised that medical aid plans will never cover the cost in full. As such it is up to them to find a solution.
State hospitals have proven to be an unfavourable choice among South Africans. They claim that the dire state of government hospitals may have an adverse impact on their health.
Gap cover premiums are cheap. Here are Zestlife’s 2025 premiums:
This cost compared to the peace of mind that one feels, knowing that they will have full control over their choice of medical care services when the need arises, makes gap cover a vital priority in their budgets.
Further, there are many brokers in SA that offer gap cover.
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