Why medical gap cover, you may ask? You have medical aid, and it claims to cover you 100% if you land up in the hospital.
Unfortunately, this is not the case. Many people don’t read the fine print connected with their medical aid terms and conditions.
It is only after an unexpected hospital stay, that they realise their medical scheme did not cover the larger part of the specialist and hospital bills.
Why medical Gap cover is Crucial financially
Gap Cover is a top-up, short-term insurance, which will help with all the medical shortfalls that your medical aid does not cover.
Medical schemes are regulated by the amount they pay for submitted claims. This is controlled by the pricing system set out for them by the NHRPL (National Health Reference Price List)- This is maintained by the Department of Health, and Council for Medical Schemes.
- The tariff your Medical Aid is willing to pay is 100% of this standard rate.
- The specialists and other health professionals do not have to adhere to this pricing system and may charge whatever they want. Sometimes this can be up to 500% of the Medical Aid rate.
- The patient is then liable for the shortfall. This can be financially crippling to the family who is already struggling to make ends meet.
Gap Cover comes to the rescue.
After your medical scheme pays their portion, your gap policy will cover most, if not all, of whatever is the shortfall or gap. So are you still wondering why medical gap cover is necessary?
This is Why you Need gap Cover
- With the cost of living is so high, and medical costs on the rise, an unexpected stay in the hospital, can put a huge drain on the family finances.
- Gap Cover also covers certain co-payments, like CT scans, MRI scans, hospital admission at a non-network hospital, and some procedures.
- In South Africa, where the crime rate is so high, an accident can force you to be hospitalised unexpectedly. Gap Cover will give you peace of mind in knowing that you will not be facing high hospital and doctor bills when you are discharged.
- Gap Cover will ensure that you can afford the best private healthcare when it is needed. Instead of putting off a procedure or operation because of a lack of funds, or even worse have to be admitted to a state hospital, you can be assured that with Gap Cover you can afford the best.
- Often Gap Cover will cover out-patient treatments like radiotherapy, dialysis, and chemotherapy.
- Have peace of mind knowing that all your family’s medical problems are being taken care of: hospitalisation, surgery, in-hospital procedures and treatments, sub-limits on cancer treatments, etc.
- Some people choose to downgrade their medical aid plan or option. They decide to have the hospital plan only and top it up with Gap Cover. This is a welcome option when money is tight.
Examples of Shortfalls you Would need to Settle, without Shortfall Insurance
- Appendicectomy – R12,053.26
- Caesarian Section – R18,413.76
- Coronary Bypass – R37,164.20
- Hysterectomy – R18,226.80
- Tonsillectomy – R18,177.79
- Wisdom Teeth Removal – R14,301.50
General Information
- Gap Cover is important for everyone, not only older people.
- It is available for individuals, or the entire family.
- You need to belong to a Medical Aid to apply.
- Some insurers have no limit on the entry age; others only provide cover to those under the age of 60.
Gap Cover has been available for quite some time. However, it has only recently gained in popularity and importance. This is no doubt due to the rising costs of quality private healthcare. Don’t delay – for peace of mind, top-up today.
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