Convenient Online Application for Admed Gap Cover™
December 10, 2021
Admed gap cover was designed to provide shortfall cover. It means the insurance pays out in the event of your hospitalisation where you require emergency medical treatment, specialists or surgery.
Shortfall insurance insures various procedures performed on an outpatient basis.
Often specialists such as GPs, surgeons and anaesthetists and other medical specialists charge rates well above the medical scheme tariff. Then the result is a shortfall which you will have to pay.
Medical aid members can apply for a gap cover quote
by completing then sending the form that appears on this page
Admed Gap Cover from Guard Risk™ – Can you Afford to be Without it?
The medical gap cover Admed offer will pay the difference between the amounts charged by the various practitioners. However, it does not include any amount that exceeds five times Admed’s tariff; minus the actual amount owed to the medical scheme.
Admed gap cover is available to anybody that has Medical Aid. In other words, the short fall insurance in the form of Admed gap cover can is applicable for anybody who is a member of a medical aid scheme. And usually, individuals need to be 65 years of age or younger to qualify for the medical gap cover.
Why You Need It and Why You Need It Now
In many cases, people with basic hospital cover or even comprehensive life cover have a shortfall. The shortfall is the gap between what the medical aid scheme will pay and what the actual cost is.
Because medical service providers are entitled to charge a great deal more than the rates set out in the National Health Reference Price List (NHRPL).
This gap is your problem, and it is up to you to cover the cost. So if you don’t want to lose money, Admed is the best gap cover to help you cover the additional expenses.
An Example of How It Works
Some medical aid plans – whether hospital plans or comprehensive solutions – only cover from 100% to 150% or even 200% of the rates and only for hospitalisation. But the reality is that actual costs could amount to as much as 400% of the listed tariffs.
Admed gap cover, a subsidiary of Guard Risk Insurance will cover the difference between the actual costs of the doctor’s bills for your hospital stay and the medical scheme rates.
Sometimes There’s a Waiting Period
Some medical aids incur a three-month waiting period from inception date, but there is an exception for emergency events.
What’s more, there could be a 12 month waiting period for maternity benefits and a general one year waiting period for any pre-existing conditions.
It’s important to confirm the benefits of Admed gap cover and understand the rules of the medical scheme. Gap cover won’t typically cover shortfalls within annual hospital limits or co-payments of specific procedures.
Medical aid members can apply for a gap cover quote by completing and sending the form on this page
All info was correct at time of publishing