What is Gap Cover many people ask, because Medical Top-Up Insurance is also called shortfall insurance. To put it simply, a policy of this nature pays all the hospital costs that are not covered by your medical aid plan.
This type of insurance has the support of financial advisers and medical practitioners. This short-term insurance product is vital when hospital costs skyrocket and you must pay the shortfall. Medical aid does not cover the entire amount.
What is Gap Cover and Do I really Need it?
It is not unheard of for doctors to refuse performing surgery on those without a gap cover. They have seen many patients unable to cover the cost because of only part payment from their medical aid scheme. Some people who need medical attention are unable to get it due to the high cost.
The public hospital in this country is not an option for them? Gap Cover gives you access to the top specialists and cuts the high cost.
Yes, you do Need it!
The gap between what your medical aid scheme pays and the cost of hospital procedures has been climbing over the years. You can’t ignore it. A single hospital admission can cost hundreds of thousands of Rands. This makes it impossible to avoid debt without Gap Cover.
Young or old, perfectly healthy or not – it really makes no difference. Everyone needs Gap cover today. Our crime rate is high, road accidents are common and everyone is at risk in one way or another.
If you are part of a registered medical aid plan, get Gap cover now, it will benefit you and your family. It’s an easy decision to make. It’s a great investment in your future and a way to protect yourself. The plan solves financial issues related to costly medical events.
Some common Shortfalls that Can happen While in Hospital :
Tariff Gaps
The shortfall between your medical aid scheme tariff and the specialists rate. It may be 100%, 200% or 300% of scheme tariff. Gap covers this difference. The maximum is 500% of the rate.
Co-Payments/Deductibles
This represents part of the hospital admission or procedure cost, which you as a member have to pay. Scans, back surgery, etc. Having Gap cover safeguards you from paying extra.
Sub-Limits
There are certain rules set by the scheme which apply to in-hospital treatment. Selected Gap provides a payment towards the costs with sub-limit shortfalls.
Cancer Treatment
Normal health care plans give only limited cover for Chemotherapy, Radiation and Cancer drugs. Gap assists with the shortfalls on this.
Issues Gap cover Does not cover :
- External Prosthetics
- Hospital accommodation
- Exclusions and procedures not included in your medical aid scheme
- Day-to-day consultations (out of hospital) with doctors/specialists/dentists/optometrists, etc
- Drugs/medicine/bandages/disposables/spectacles, etc
- Pathology (blood tests) and x-rays out of hospital
- Penalties levied to members for use of non-network hospitals, non-authorization, etc.
Gap cover – it’s the only way to stay ahead of rising costs and a debt mountain.
