Gap Cover and Diabetes
May 7, 2019
Adult-onset diabetes is a lifestyle disease that is becoming increasingly common. At the same time, medical aids are paying less of your medical expenses. That’s why you may have questions about medical gap cover and diabetes.
The typical Western diet and our more sedentary lifestyles make for a perfect storm when it comes to diabetes.
Diabetes in Africa
In Africa around about 78% of cases of diabetes go undiagnosed. The primary problem is that the disease can progress quite far without you even realizing it.
The Prognosis for Diabetics
This is a deadly disease – it may act slowly but the damage done can be quite severe. If caught early enough, it can be controlled by diet to a certain extent.
For most people, however, the disease progresses to a stage where medical intervention is essential.
This entails taking chronic medication for the rest of your life. Proper management of the disease and regular consultations with your doctor are essential.
If the disease is not brought under control, the effects over the long-term can range from deterioration of the eye sight through to renal failure and diabetic neuropathy.
Diabetics are not able to heal as quickly, and neural damage caused by the disease can lead to them developing serious infections, particularly in their extremities.
What Does This Mean Later in Life?
While the prognosis if good if you can keep the disease in check, the consequences of not doing so are severe.
Infections, especially of the extremities can lead to gangrene developing, resulting in the need for amputations and prosthetics.
Renal failure may make it necessary to undergo dialysis or have a kidney transplant.
These procedures can be extremely expensive.
Won’t My Medical Aid Cover Me?
By law, your medical aid must pay out the prescribed minimum benefits when it comes to the treatment of this disease.
These payments will be considered chronic benefits and will not be deducted from your medical savings account.
That said, the medical aid can place restrictions on where you can receive your medication from. They may also restrict cover to standard medical aid tariffs.
What this means for you is that you will be able to get your medication but that you may need to pay out of pocket.
If your health care provider is charging more than the standard medical aid tariff, you will need to pay the difference.
Gap Cover and Diabetes
The cost of the medication for the treatment of diabetes are high enough, the cost of hospitalization as a result of complications can be astronomical. So gap cover and diabetes are inseparable.
You might find yourself in a situation where your medical aid will only pay for emergency treatment. You may find that they won’t cover the full cost of prosthetics.
A common misconception is that the medical aid will pay all costs related to hospitalization.
Whilst this is true in theory, most policies will pay out regarding the standard medical aid rate as they lay out in the policy.
The problem with this is that medical professionals can charge what they like. They can, and often do, charge double or triple these predetermined rates.
And the difference will be left for you to pay. For complete peace of mind as a person with diabetes person, gap cover is no longer a nice-to-have but a necessity.
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All info was correct at time of publishing