Medical shortfall Cover in South Africa and You

There are many reasons to get medical shortfall cover South Africa.

Medical aid members sometimes find themselves with a huge unexpected medical bill after hospitalisation.

They were under the impression that their medical aid would cover all their medical expenses in full.  These real life experiences are why more and more people in South Africa get gap cover.

The stress and anxiety caused by these bills rob many people of their chance to heal and recover. Since they must constantly worry about finding money to pay for the shortfall.

Medical shortfall cover South Africa takes Care of the Excess

Medical shortfall cover South AfricaGap cover for medical expenses in South Africa is a short term insurance over and above one’s medical aid cover.

It covers the gap between what experts charge and what health schemes pay out.

While medical aid schemes get their pricing guide from the National Health Reference List, healthcare providers do not need to adhere to this guide.

They often charge as much as 3 to 5 times what the pricing guide dictates.

Where the medical aid company states that they cover 100% of their rate, what they mean they will cover the medical bill in full up to the rate stipulated by the NHRPL, anything over and above this rate is the patient’s responsibility to pay.

Medical shortfall cover South Africa ensures for this shortfall, to pay the difference, so the patient will not have to worry about it.

How can I get Shortfall cover in South Africa?

To become a member of a gap insurance plan in South Africa, one has to be a member of a medical aid scheme. All the members covered under the principle member of the medical aid can also be beneficiaries of gap insurance.

Insurance companies will usually apply a three month waiting period before one can lay any claims. If one has any pre-existing conditions on commencement of the policy, this waiting period is extended to 12 months.

They usually also do not accept claims over six months from the invoice date. Typically, one has to submit their claim to medical aid first and then claim from the gap cover what has not been paid by the medical aid.

Some Gap cover insurers also set age limits to joining their cover, e.g. some will not accept a new member over the age of 60, while some have no such limits.

Further, with some insurers, there is also a limit to total claims per year for certain ailments. The overall cover will depend on how comprehensive the cover taken is.

While some premiums can be as low as R65 monthly, more comprehensive cover will be more expensive than this.

In most cases the more you pay, the more you will get out of it.

Get a Quote for Shortfall Cover in South Africa. Just complete and submit the form. It’s FREE!

All info was correct at time of publishing