Gap Cover for Medical Aid is Important!

December 9, 2021

The reason why Gap Cover is important is very simple.

It could save and your family from financial ruin.

Gap Cover was created as a top-up short-term insurance policy. A gap policy pays in the difference between your medical aid’s stipulated tariff rates and what the medical profession charges.

That difference can become tens of thousands of Rand. That’s because medical professionals do not have to follow the Government’s tariff rates or those suggested by medical aid schemes.

Imagine this nightmare scenario

Important Information for South African Medical Scheme Members

Let’s say you have to undergo an emergency heart operation. Your medical aid is prepared to pay R150,000. However, the final bill from your health care providers amounts to R500,000! Finding an additional R350,000 to settle the account amounts to nothing less than a nightmare but, with Gap Cover, you can rest easy and recuperate because it will pay in the difference.

Important: Gap Cover is a necessity

It is not difficult to understand why Gap Cover is a necessity. Think of it as you would any short-term insurance policy. It is similar to safeguarding your home against burglary or your motor vehicle for accident repairs. The cost of medical treatment is expensive, very expensive. To take care of yourself and your family, Gap Cover is the only way to go.

Gap Cover policies cover you and all your family members, provided they are also beneficiaries of your medical aid scheme.

The beauty about Gap Cover is that you can build a product to suit your personal needs – the more benefits you choose the more you will obviously pay but, nevertheless, this form of insurance is really affordable and can be streamlined to suit your monthly budget.

The 100 per cent anomaly

Consumers, understandably, find it difficult to understand why their medical aid schemes say they pay 100 per cent when, in reality, most of the time the payouts are in the region of one-third of the bill. The reason for this is that medical schemes work to a prescribed tariff rate which is generally way below what medical professionals charge their patients. That is why it is imperative that you investigate and understand where those shortfalls could affect you and your family and insure against possible financial ruin in a Gap Cover policy designed to meet your needs.

Not only does Gap Cover absorb the difference in the medical aid’s prescribed tariff rates and what members of the medical profession charge for their services, but it also acts as a top-up short-term insurance for unforeseen hospital fees and treatments, surgery, emergency operations, extending to out-patient treatments such as chemotherapy, dialysis and radiotherapy.

Important: How gap cover works

Like any other short-term insurance, medical Gap Cover operates over a calendar year, making it much easier for you to work out a budget you can afford. It covers you, as the principal member, plus your family members added to the policy as beneficiaries. It’s an affordable product that buys you a great deal of peace of mind.

Another plus factor is that Gap Cover, depending on the product you select, allows policyholders to lodge claims for the return of co-payments imposed by medical aid schemes for procedures such as CT scans, endoscopies and MRIs. This can be an extremely lucrative benefit if your medical aid plan does not include a savings plan.

You must be a member of a medical aid to apply for Gap Cover. Complete the form on this page and you will receive your personal quote.

All info was correct at time of publishing