Only medical scheme members can get Gap Cover. It is a known fact that most South Africans have to rely on State hospitals when they need to undergo surgical procedures.
However, for the minority who are fortunate enough to have medical aid, the cost of treatment can still be a daunting financial nightmare.
Fees charged by the medical profession way outstrip payments medical schemes are prepared to make for different hospital procedures.
This leaves the member of the medical aid with the problem of having to find extra funds to cover hospital costs – sometimes up to five times more than what their scheme will pay.
That is where Gap Cover kicks in – it pays the difference between medical scheme payouts and medical fees.
However, there are different levels of Gap Cover. The costlier the insurance policy, the more benefits it will have on offer. Hence the more it will pay out to cover extra hospital costs.
So read the fine print with care, or better still, obtain advice from a broker.
Who Qualifies; Only medical scheme members
It is vital to remember that only medical scheme members of a listed medical aid company qualify for Gap Cover.
The policy will cover the principal member as well as his spouse or life partner and children.
They must be registered members of the same medical aid scheme.
South Africa has some top class medical aid schemes from which to choose, including household names such as Bonita, Discovery and Momentum.
Still, we urge consumers to do their homework before selecting a medical scheme.
They must familiarise themselves with the inclusion and exclusion clauses before deciding on a scheme to best suit their lifestyle and financial means.
Speaking to a broker can also go a long way to clear up any confusion before committing to a particular medical aid.
While some exclusions are more specific, other are standard and apply to most Gap Cover policies.
- No nuclear cover, including materials, weapons and fallout
- No cover for cosmetic surgery or obesity treatments
- Routine physical examinations, X-rays or laboratory tests- no cover
- No mental disorder cover
- No suicide cover
- Drug addiction cover or medication unless prescribed by a medical doctor- no cover
- No alcohol abuse cover
- No cover for members of the military, police, police reservists or active civil uprising,
- labour unrest, riots, strikes, or the activities of locked out workers
- Aviation cover unless the policyholder is a passenger- no cover
- No cover for any form of speed or race test
- No cover for costs involved with private nursing
Gap Cover is a form of short-term insurance.
It can be implemented no matter which scheme is used, or how many times a policyholder may change their medical aid. Only medical scheme members can get Gap Cover.
Mostly, Gap Cover can be obtained for less than R400 a month, giving policyholders peace of mind since additional costs will be covered when they are hospitalised.
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All info was correct at time of publishing