Admed Medical Gap Cover FAQ

    Apart from paying a bond and paying for your car, having a medical aid ranks high on the list of must-haves. Without a medical aid, an illness or injury could put you at the mercy of a state hospital. They’re so understaffed and under-resourced you may well have to share a bed with 2 others. The only way you exit such hospitals is in a coffin. Even though some 8 million South Africans belong to a medical aid, they’re not entirely thrilled with their lot. Their expensive medical aids don’t always pay in full for their treatments, making gap cover a critical necessity. There are many gap cover providers of which Admed is one.

    Get Your Admed Questions Answered

    Admed provides cover for the gap in the amount specialists charge you and the amount the medical aid will pay. The amount the specialist charges can well exceed the Medical Scheme Tariff by as much as 5 times. These huge gaps, running in thousands of Rands, will be for you to cover…unless you have gap cover. We answer some questions that people have regarding this brand of medical gap cover.

    Who is eligible for gap cover with Admed?

    You need to be an active member of a South African medical aid. Gap cover isn’t a medical aid and it also doesn’t cover you for EVERY shortfall there is.

    Does Admed cover out-of-hospital procedures?

    Yes, a list of procedures can be found in the Admed policy. \The company also won’t cover procedures which are performed beyond South African borders.

     Are there waiting periods for new policy holders?

    Yes. – 3 month general waiting period –  month procedure-specific waiting period – 10-month birth-related waiting period

    How old must one be to apply for gap cover with Admed?

    – individuals over the age of 65 may not join Admed unless they’re part of an employer group – your spouse and dependents won’t have cover if they are older than 64. – once you have applied for cover with Admed, you have cover while you pay your premiums Admed Medical Gap Cover

    What gap cover benefits does Admed offer?

    – co-payments applied for certain procedures as well as co-payments levied by the scheme on oncology treatment programmes – a lump sum paid out for accidental death and permanent disability, for a first-time cancer diagnosis and for long term hospitalisation – shortfalls for internal prosthesis costs – a fixed benefit for teeth treatments because of accidental injury

    What is this Hello Doctor benefit?

    Its a service provider making use of your mobile device. This means you have personalised healthcare advice anywhere, anytime. Day and night, you can ask a qualified medical doctor any health related question. There are educational videos and you can also keep up to date with information by following Hello Doctor on Facebook and Twitter. Visit the Hello Doctor website at www.hellodoctor.co.za.

    More Questions Answered

    What will I pay each month for gap cover from Admed?

    – With Supreme Gap cover, you’ll pay R199 a month – With Primary Gap cover, you’ll pay R159 a month Unlike other gap cover providers, if Admed doesn’t  receive your premium for a month, they will take a double payment the following month. During the month you didn’t pay the premium for, you will still be covered, but no claims will be paid until your premiums are up to date. Premiums are collected each month by way of debit order from your bank account. Just remember that Admed can terminate your policy if you continue to not pay your premiums. They will also terminate your cover if you provide false information for gain.  Also if you withhold important information which could influence Admed’s decision to accept you for cover, they will terminate your policy.

    Must you take Comprehensive gap cover with Admed?

    No, Admed also offers Primary Gap for those wanting a less comprehensive gap cover solution

    What does this Primary Gap cover offer?

    Cover for co-payments applied by the medical scheme for certain procedures cover for shortfalls with medical practitioner costs (PMBs excluded)

    How do I claim from Admed?

    You can find claim forms on the Guardrisk website – www.guardrisk.co.za/en/products/admed. Remember claim forms must be accompanied by all related documents And you can’t take forever with a claim. If you don’t submit your claim in writing within 6 months, Guardrisk will reject your claim. You can contact the call centre on 0860 102 936 You can also email claims to admed@guardrisk.co.za

    When you do put in a claim withAdmed how do they pay?

    Admed doesn’t pay a claim to a medical service provider, but pays a claim to the policyholder. The policyholder is then responsible for settling the account. The claim takes between 7 to 10 days to process. If they don’t receive the correct documentation, then the claim takes longer.

    How is Guardrisk linked to Admed?

    Admed is one of the products of Guardrisk. Guardrisk Life Insurance is a renowned corporate insurer who started out in 1999. The provide insurance tailored for your corporate needs. Guardrisk has received many accolades for the services and products they offer and the way they run their business.

    What kind of shortfalls has Admed paid?

    Cardiac By-pass surgery can be massively expensive. Admed has paid for this very recently. The by-pass surgery was R92 130.37 of which 100% of scheme tariff meant the medical aid paying R46,199.75. This left a shortfall of R45,931.02 which Admed paid. Were it not for gap cover, the medical aid member would have had to pay for this out of their own pocket. Another common operation is a hysterectomy. The costs involved are R25 521.22. The shortfall was R45,931.02 of which 100% of scheme tariff was only R7,278.54. You can see with these two operations, without gap cover, people would either have to give up on the operation, take out a loan or borrow the money from somewhere.

    How to Cancel if the Need Arises

    You can cancel your Admed policy whenever you want to, but you must advise them about this in writing and you must also give them a month’s notice so as to cancel your policy.

    To get a FREE gap cover quote, please complete and send the form on this page