Have you ever had to pay an additional medical expense that you though your medical aid would cover? Or you got the shortfall bill from a specialist that your medical aid did not cover? If your answer is yes to any of these. You should avoid these self payment gap problems, and get gap cover.
Important Note about Medical Aid funding
- Medical aids will usually offer to pay between 100% and 400% of the hospital medical rates. This means that they will pay 100% of their particular rates. In most cases, Medical Aids use the rates which they list by the National Health Reference Price List. ( NHRPL)
- If the final bill is above the amount specified in the rates, then the member is liable for that amount.
- Medical Aids often request an up front co-payment for some procedures carried out in hospitals and doctors rooms. The member is responsible directly to the supplier for this.
- Specialist and Doctors fees have risen dramatically over the last few years. Such specialists do not have any regulations of what they may charge. While Medical Aids do contract to some specialist (Designated Service Providers), there is often additional bills to pay.
- As the number of cancer cases increases many of the Medical Aids are placing limits on the maximum funds available for cancer patients. The maximum limit can be easily and frighten quickly reached.
Statistics regardings self payment gap problems
Medical Aid Companies do not publish any statistics relating to the amount of shortfalls that their members must have self fund. However, unless the member has chosen an expensive option, it is safe to say that members will have to pay out cash for top up bills after a hospital visit.
They can raise co-payments between R1000 to R 8000 depending on the procedure and medical aid. With Specialist fees having increased 225 % over the last few years it is obvious that scheme members have themselves to meet the gap. Medical Aids allow and encourage Gap Insurance as if they had to pay out the total bill for all hospitalisations and treatments the scheme would be broke fairly quickly.
Answer To coverage For self Payment
A person who is a member of a medical aid scheme can take out Gap Insurance. Even for a small fee every month you can get quite a good gap cover plan. This insurance will cover the whole family and will pay out most shortfalls as listed above.
Fill in and submit the form on this page to get your one FREE gap cover quote
All info was correct at time of publishing