You may think that your medical aid is your knight in shining armour because they pay all your medical expenses, but this is not the case. 1Life has a different view of medical cover.
When you are admitted to hospital your doctor charges more than the standard scheduled fee. The over-and-above-amount you must pay. The only way you can avoid these shortfalls is to investigate gap cover. Having gap cover comes with benefits and 1Life discusses its benefits –
This gap cover is a short-term insurance product. Specialists can charge up to 500% more than what your medical scheme covers. Without medical gap cover, an illness or injury can see you having to part with massive sums of money.
What a 1Life financial adviser say
s1Life spoke to Ricky Rohrbeck of Select Independent Advisers. As an independent financial adviser, it is interesting to see what he has to say about the ins and outs of gap cover.
Each year medical aids set a certain rate – the base rate that medical professionals can charge for procedures. The medical aid will pay up to 300% of this rate. If the specialist charges way over this, you must pay the surcharge.
Ricky went on to say that this gap cover isn’t medical aid, but rather an insurance product that 
Gap cover is also known as top-up insurance and to claim from it you will need to submit your hospital bill as well as a statement of the shortfall from your medical aid. Once you receive the gap cover, you will need to pay the specialist or hospital.
Reasons to have gap cover
The cost of gap cover is within everyone’s reach. Whether you are an individual or a family, premiums are the same and start from roughly R180 a month, depending on the cover.
1Life opted to get a quote from 5 different gap cover providers.
- All of them offer cover for up to 500% of medical aid rates.
- They all offer sub-limit cover.
- They all offer co-payment cover.
- Cancer co-payment cover or oncology benefits were also included.
Understand what’s on offer
It is important to always read the fine print and make sure you understand what percentage of medical aid rates the gap cover goes up to. Certainly you want to know what exclusions there are.
There is some gap cover that offers dental benefits but here again make sure you understand precisely what is on offer before you sign for anything.
When you start researching medical gap cover there are several terms that you will hear over and over again. You should familiarise yourself with the terms.
- Tariff gap is one. This is the shortfall between the cost of a procedure that your medical aid will cover, and what the hospital charges you.
- Co-payments is another. Some procedures require that you first make a co-payment – a fee that the member is liable for if they want certain medical procedures.
- Sub-limit cover. If you have a procedure for instance, that costs more than the sub-limit, you will have to pay in yourself. Having sub-limit cover means that the gap cover will take care of the additional procedures over and above your sub-limit.
- Cancer co-payments or oncology benefit. There are some cancer procedures and medications that may not be covered by your medical aid. You may have to make a co-payment for some of the procedures you have. This is when the oncology benefit kicks in.
If you’re looking for a medical aid plan, compare them before you sign up for one. Look very carefully at co-payments and deductibles. You have to know whether a medical aid is in fact good value. Whichever medical aid you settle on, you will need medical gap cover.
The premiums aren’t that expensive and the benefits can spare you a lot of terrible financial anguish.
Complete and submit the form on this page to request your medical gap cover quote