In this article, we will go through how your Universal Gap Cover policy from Liberty works. Gap cover is something that is separate from your medical but equally as important.
The Universal plan from Liberty covers you, one spouse and dependents that you have on your medical aid.
Isn’t My Medical Aid Enough?
Ten or twenty years ago, it may have been but medical aid cover has changed a lot. Medical aids need to limit their potential liability so that they can remain profitable.
This means determining at the beginning of each financial year how much they will pay per procedure. They do this by forecasting what premiums they expect to get and doing an analysis of claims from the year before.
This helps them to establish a base rate or “medical aid rate” on which to base payouts. Depending on
the plan you are on, they might pay 100% or 200% of these rates.
If your medical specialist charges these rates, you are covered.
What if the Medical Professionals Charge More?
This is where things get a little more complicated. Your medical aid will pay out in terms of the rates that it sets. Your medical professional does not even need to take these rates into consideration.
And most charge quite a bit more than the medical scheme rate.
The shortfall is then left for your account.
Do I Really Need Gap Cover?
It is for exactly these situations that gap cover comes into play. They will pay the shortfall, once your medical aid has settled their portion of the account.
Let us say, for example, that Sarah needs to have her appendix removed. Everything goes smoothly and she is back home after a couple of days.
Her medical aid pays 200% of medical aid rates so she is not concerned.
The problem is that the doctor has charged 400% of the normal medical aid rate.
This leaves her with a shortfall that matches what the medical aid did pay for. Now, taking into account, the cost of the surgeon, anaesthetist, etc. this could mean a few thousand Rand. She is now in the unenviable position of needing to find money to pay this debt.
Universal Gap Cover Policy from Liberty
If she had the Universal gap cover policy from Liberty, she would have been covered. The policy pays up to 500% of the standard medical aid rates. There is no maximum limit for claims.
Claiming from Your Gap Cover
Universal gap cover policy claims are a fairly simple process, as long as you submit all the requisite documentation.
You will need to wait until your medical aid has paid their portion before submitting a claim. You will need to complete the appropriate claim form and attach supporting documents.
The claim, if approved, will be paid into your personal banking account. At this time in South Africa, this money must be paid to you. You are then responsible for ensuring that the outstanding bills are paid.
Most people view gap cover as an optional extra. Considering how expensive medical treatment has become, this can be a significant mistake. It is better to be prepared by taking out gap cover before a medical emergency occurs.
Complete the form then submit it to get your one complimentary gap cover quote!
All info was correct at time of publishing