Anglo Medical Scheme Gap Cover

December 14, 2021

As a medical aid member o Anglo Medical Scheme or any other scheme in South Africa, in most instances, you’re going to find that the cost for in-hospital procedures is going to exceed the medical aid rate by 5x.

Without medical gap cover, you are going to have large excess amounts to settle that can sink you financially.

If you want this all-important gap cover, you have to be a member of a registered medical aid scheme. One of the gap cover providers in South Africa is Anglo Medical Scheme.

Anglo Medical Scheme is a restricted Scheme. The medical scheme is for employees of participating employer groups.

Anglo Medical Scheme members experience out-of-pocket expenses

Anglo Medical Scheme members have themselves experienced big out-of-pocket expenses for in-hospital procedures. This has resulted in shortfall amounts that they have had to pay for.

Anglo Medical Scheme Qualifies for Medical Gap Cover

If you are a Standard Care Plan member, Anglo Medical Scheme pays providers 100% of the Scheme Reimbursement Rate. Those members on the Managed Care Plan have a top-up rate. This amount is up to 230% for certain in-hospital services.

Why gap cover is so imperative

Thankfully, short-term insurance products have come to the rescue and this has funded these shortfalls. This is what medical gap cover is all about.

These gap cover products are regulated in terms of the Short- or Long-term Insurance Acts. The most common gap products are these medical expense shortfall policies, covering the shortfall between scheme benefits and what the medical specialist charges.

Some of these health care providers are capable of charging rates that are as high as 500% or more than the medical aid rate.

Anglo Medical Scheme gap cover has limits

Understand the limits of your gap cover because the cover is subject to an overall annual limit of  R150,000 as an example.

Gap Cover assists with the fees connected to sub-limits, co-payments as well as other medical expense shortfalls. Because this gap cover has limits, choosing the right cover to complement your medical aid is a necessity.

Medical aids also change every year and as a member of a medical aid you need to familiarise yourself with the changes. You need to make sure that you have the gap cover in place to cover these changes.

You have to think of cover for co-payments, sub-limits and deductibles. Certain gap cover will take care of medical expense shortfalls that come about because of you reaching your scheme’s sub-limit for a particular benefit. Or it may be because the scheme imposes a co-payment.

Also, all gap cover imposes certain waiting periods for new policyholders. Certainly, if you have a chronic, long-term condition, you will need to pay attention to the waiting periods required by your gap cover.

The experience of AMS members

Some of the Anglo Medical Scheme members expressed their views on gap cover. Some 83% of members said that they found it valuable while 58% said they wouldn’t buy it as they believed it wasn’t necessary – for now.

The medical scheme suggests that because there are different aspects to gap cover, it is recommended that medical aid members read the gap cover’s fine print and get advice from a financial advisor

For every Anglo Medical Scheme member, gap cover providers will need to be reviewed carefully and regularly. This is to ensure that they are still meaningful and that each member of the scheme isn’t spending money on benefits they don’t actually need.

When you complete and submit the form on this page to request
your complimentary gap cover quote. Act now!

All info was correct at time of publishing