Why Medical Gap Cover is Popular in South Africa

The massive popularity of Gap Cover has been a cause of the medical shortfalls that medical aids do not pay. Despite exorbitant monthly premiums, most members still do not have sufficient cover.

The rise in Popularity of Gap coverĀ 

Statements by medical schemes that they cover 100% of hospital fees are not strictly true.

Yes they do pay 100% of their fixed medical tariffs, but those ceilings are way below what the medical profession charges for their services. Surgeons, Anaesthetists and radiologists are known to charge up to five times more than the amounts covered by medical schemes.

Who Pays the Difference?

Popularity of gap coverThe difference between the medical scheme tariff and that imposed by the medical profession is the sole responsibility of the medical aid member.

This burden can have disastrous consequences for cash-strapped South African families and is also a reason for the growth in popularity of gap cover.

What is Gap Cover?

Gap Cover is a form of short-term insurance that pays the difference between medical aid tariffs and medical profession costs for hospital procedures.

Gap Cover will pay up to five times the amount covered by medical schemes, giving policyholders financial peace of mind during times of illness.

What does Gap Cover cost?

Gap Cover can be obtained for around R274 monthly per family, making it an attractive and affordable option to safeguard against sudden and significant financial losses.

Who Qualifies?

All members of a registered South African medical scheme qualify for Gap Cover.

Co-Payments

Gap Cover policies can include Co-Payments, but this is an optional extra and will involve a higher premium.

Co-Payments are excess amounts stipulated by medical schemes and the financial responsibility of its members. These Co-Payments include MRI and CT scans, ultrasounds and scopes, as well as hospital admissions.

Co-Payment Examples

  • Hospital procedures for impacted wisdom teeth can cost members up to R5 250
  • Gastroscopies can charge members up to R3 900
  • MRI and CT scans can cost members up to R2 900
  • Hospital admission fees can cost members R1 200

Exclusions

There are some exclusions involved with Gap Cover and consumers are advised to read the fine print carefully before committing pen to paper.

Some of these exclusions are:

  • No nuclear cover, including materials, weapons and fallout.
  • Cosmetic surgery or obesity treatments.
  • Routine physical examinations, X-rays or laboratory tests.
  • Mental disorders.
  • Suicide.
  • Drug addiction or medication unless prescribed by a medical doctor.
  • Alcohol abuse.
  • There is no cover for members of the military, police, police reservists or ongoing civil uprising, labour unrest, riots, strikes, or the activities of locked out workers.
  • No aviation cover unless the policyholder is a passenger.
  • There is also no form of speed or race test.
  • Also, there are no costs with private nursing.

Conclusion to why the popularity of gap cover is growing

Despite regular waiting periods for pre-existing conditions, Gap Cover becomes active the moment the policyholder pays the first premium. It is also important to know that Gap Cover remains in force even when the policyholder changes from one medical scheme to another.

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All info was correct at time of publishing