No matter how unfair it seems, South Africans have come to realise that stand-alone medical aid is simply not enough to meet their medical costs. Hence, it is vital to know which medical gap cover is best.
The cover offered by schemes falls way below the reality of bills charged by health experts.
Clients rightfully ask why they should pay the difference. Especially when insurance companies charge top dollar for medical aid.
Sadly, unless they face reality and add Gap Cover to their medical insurance, they will have to deal with a financial nightmare when it comes down to covering health costs.
The cold hard facts are that medical schemes pay standard rates for various procedures.
The medical profession, on the other hand, charges far more than medical scheme tariffs, leaving the members to foot the difference.
Those differences are often five times higher than medical scheme rates.
In other words, Health experts charge up to R50000 for a R10000 hospital procedure, leaving the consumer with an R40 000 shortfall.
What is Gap Cover?
Gap Cover is a form of short-term insurance that will pay up to five times more for treatment than the standard rates paid by medical aid schemes.
Gap Cover is cheap, starting at monthly premiums below R100. Further, charges for the average insurance policy is about R200 a month.
Like all insurance, the higher the monthly premium, the more benefits are built into the policy.
Members purchase Gap Cover as an add-on to their medical aid.
The only requirement to obtain Gap Cover is that applicants must be members of a listed aid scheme in SA.
Which Medical Gap Cover is Best for You
One cannot single out a particular gap cover policy as the best on offer to South African consumers.
Many companies offer gap cover. We urge clients to research all options before choosing a plan that best suits their health needs and budget constraints.
Here are just a few of the Gap Cover options available:
What is offered?
Most of these companies have similar conditions built into their Gao Cover policies:
- A 12 month waiting period for pre-existing medical conditions and pregnancies
- Simple claims procedures provided that these are submitted within six months of hospitalisation
- Claims paid directly to the client who is then responsible for settling private practitioner bills
- Gap Cover for the principal member, his wife or life partner and children, provided they are all members of the same medical scheme.
- The policy covers procedures such as dental surgery and oncology treatments, depending on the product chosen.
We urge consumers to shop around before picking a Gap Cover plan. So that the can find out which medical gap cover is best suited to their needs. Also, consult with a broker who can give the best advice on which option could be best for the entire family.
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All info was correct at time of publishing