Different Types of Gap Cover

December 14, 2021

Different types of gap cover are available to help people in South Africa. It is for people who have a medical aid but still face huge medical bills.

Most people assume that with a medical aid, they have cover for all their medical bills. After all, that’s why they’ve got a medical aid in the first place.

Unfortunately the truth in South Africa is that specialists can overcharge as they wish because there is no regulation.

Specialists and private hospitals are accountable to no-one. And you have to somehow pay the amount that the specialist charges. And this amount is usually well above what the medical aid will pay.

Medical aid members can apply for medical gap cover
by completing and sending the form on this page

Different Types of Gap Cover – And Medical Aid Co-payments

The National Health Reference Price List (NHRPL) dictates the rates  your medical aid scheme must pay.

Different Types of Gap CoverSo if a specialist charges R10000 for orthopaedic surgery, but the medical aid tariff is R6000, then you have to pay R4000.

Your medical aid must by law to pay out a certain amount. And that is not the amount many specialists charge.

These specialists and hospitals do not have to charge these rates so they sometimes charge 300% above NHRPL prices.

So you may believe you are financially covered for medical treatment but you are not. You will be liable to pay out for the shortfall. For instance, for a regular tonsillectomy, the operation will cost R12,297.70. Your medical aid will pay R4,119.9, so you have to find R8,177.79.

For coronary bypass which costs in the region of R40,000, your medical aid will pay R13,000, leaving you to make up the shortfall of R27,000.

Different Types of Gap Cover – Gap Cover Prevents Bankruptcy

Because medical bills can leave you bankrupt, you need to choose gap cover carefully, especially seeing that it isn’t part of your medical scheme.

The Council for Medical Schemes and the Medical Schemes Act regulate your medical aid, while gap cover falls under the Short-term Insurance Act.

You may see gap cover as just another kind of medical aid to supplement the inadequate medical aid you have. The fact is, without gap cover you won’t be able to meet your medical bills.

Cover the Gap.co.za allows you to compare different types of gap cover and choose the one that meets your needs. For instance: Liberty Gap cover is R 207per family per month whereas Sanlam Comprehensive is R152 pfpm and their Standard Gap Cover is R125 pfpm.

When you see the different types of gap cover, you see why it is so important to compare until you find what suits you.

Liberty gap cover requires no underwriting, there are no restrictions on the number of children you can include and wives on different medical schemes can have cover under the same policy.

Different Types of Gap Cover – Sanlam Gap Cover

Sanlam Gap Cover offers the Comprehensive Gap Cover.  This includes in-hospital treatment and some out-of-hospital treatment benefits.  Enhanced hospital cash benefits are only available to Sanlam Reality members.

For more information on the list of additional benefits and exclusions please check out the PDF document at SPF757_Gap Cover_Top Performer May 2018

Different Types of Gap Cover – Don’t be Caught Off-Guard

You should get a proper comparison between the different types of GAP cover schemes.

This way you get adequate protection so that you’re not left high and dry when you come against the inadequacies of your medical aid scheme.

Medical aid members can apply for one FREE medical gap cover quote
by completing and sending the form on this page

All info was correct at time of publishing