Once you discover medical gap cover, you’ll quickly see how it assists you financially when you’ve had private medical treatments. Your first question will be ‘why isn’t my medical aid paying for all medical treatments, after all, I pay a small fortune in monthly premiums’? Indeed, Gap cover is for medical scheme members who want to avoid this pitfall.
The truth of the matter is that your medical aid isn’t going to pay for any bills which are over the tariffs. These tariffs have been set up as a guide on how much experts should charge. Gaps occur when a specialist charges a much higher fee than what the medical scheme tariff guidelines suggest.
You Must First Belong
Gap cover is for medical scheme members only. You have to belong to a registered medical scheme to be able to buy gap- or top up cover. South Africa has more than 100 medical schemes, and some examples include Genesis, Fedhealth, Momentum, Bonitas, Selmed, Resolution and Discovery. It doesn’t matter which medical aid you belong to.`
If you change medical aid schemes, your gap cover stays the same. The Council for Medical Schemes watches over them. They are a permitted body set up by the Medical Schemes Act to supervise private health financing through the different schemes.
Compare Medical Schemes
Between all these medical schemes there are about 9 million beneficiaries who rely on an array of options and benefits. There are websites which do an excellent job comparing some of these options. For a full breakdown of medical aid schemes, you can always visit Medical Plan Advice.
You’ll find information on hospital plans, day-to-day cover as well as network plans. You can even call them on 021 712 8866 for further assistance.
Enormous Premiums and yet there are Shortcomings
Hospital plans cover your hospital costs and will include services like anaesthetist and surgeon fees. They come with a limited savings account for day-to-day use. Comprehensive medical aid plans are what everybody would like, but sadly, just a few South Africans can afford them.
Premiums for these plans can be in the region of R6 000 a month, and yet there are shortcomings. Many people discover that after undergoing surgical procedures on a comprehensive medical scheme cover, they still had a shortfall which they had to pay.
Medical scheme rates differ between schemes. Doctors independently determine their own rates, which can be as much as 5x the medical scheme rates.
Gap Cover is for Medical Scheme Members who don’t want a Financial Nightmare
You can ensure full payment of your costly medical bills by firstly, belonging to a listed medical scheme, and then, to invest in Gap Cover.
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All info was correct at time of publishing