What is Medical Shortfall Cover?

If you’ve been caught off guard and had to pay huge medical bills which your medical aid didn’t pay, you’ll know by now exactly what is medical shortfall cover.

Medical aid cover in South Africa is a critical necessity. And yet, even when you have cover, it’s not always enough.

It doesn’t cover everything you’d expect since you pay such a significant premium in the first place.

Many South Africans have discovered too late what medical gap cover is and how it helps medical aid members pay their enormous fee in hospital bills.

What is Medical shortfall Cover?

What is Medical shortfall Cover and How can I Benefit?

For as little as R80 a month, you can save yourself thousands of Rands on practitioners fees.

Medical gap cover will save you the stress of wondering if you’re going to have to sell your house to pay for the medical treatments you believed were covered by your medical aid plan.

Did you know that just about all private medical practitioners charge between 101% to 500% above the standard medical rate? Your medical aid works according to the medical scheme tariff guidelines, and anything above this they won’t pay. They leave that amount for you to pay.

Without gap cover, there are some medical bills for heart surgery that will mean your medical bill being in the region of R500 000. Have you got this sort of money to draw on? Very few South Africans do.

Gap cover is for Singles as Well

Don’t for one minute think that if you’re single and healthy, gap cover doesn’t apply to you. Illness and injuries don’t pick sides, they strike out of the blue.

What is Medical shortfall Cover and do I qualify?

To be eligible for a medical aid gap cover policy, you need to be a member of a medical aid scheme which is registered with the Registrar of Medical Schemes.

There are more than 100 registered medical schemes in South Africa, open and restricted. Gap cover will provide you with additional coverage when your medical aid scheme doesn’t pick up certain claims in full.

You can’t assume your cover will pay 100% of the costs associated with medical procedures. This 100% doesn’t mean comprehensive cover. Call your medical scheme for clearance on this misunderstanding with many medical scheme members.

Private health Care

Health care specialists charge what they like for their services, and medical aid schemes aren’t prepared to pay these bills in full.

  • Some medical gap cover underwriters may exclude pre-existing conditions
  • You don’t require a medical examination for gap cover
  • Medical gap cover has waiting periods – mostly three months general waiting period and 12 months of pregnancy and child birth

The reality is that medical aid schemes cover members with minimum health care benefits but with maximum payments each month.

The question is can you afford not to have a medical aid top up policy’? It’s no longer a luxury but a necessity, without which you would never be able to go into hospital for any length of time.

Please fill in the form on this page to get a FREE gap cover quote

All info was correct at time of publishing