Gap Cover for Primary Medical Aid Members
November 24, 2024
f you have to go to a hospital, the last thing that you want to face during recovery is a pile of unpaid bills. That is why gap cover for primary medical aid members and their dependents is so important.
Ten or twenty years ago, you could have been secure in the knowledge that your medical aid would cover the full cost. Unfortunately, times have changed.
To become more cost effective, medical aids are tightening their belts. They use data garnered from previous claims, etc. to determine what they will pay out for hospitalization.
The problem is that these predetermined tariffs seldom keep pace with what medical professionals charge. That leaves you in the unenviable position of having to find money to pay the difference.
How to Bridge the Gap
Gap cover for primary medical aid members is an insurance product that will pay the costs not covered by your medical aid.
Admed will cover you for procedures conducted in hospital and for some procedures you have as an outpatient.
The cover will be the amount of the shortfall, up to a maximum of double what your medical aid paid out. That means your payout will depend on the amount that your medical aid pays.
Admed Supreme Cover Includes
That is the most comprehensive cover.
If you choose Admed Supreme Gap insurance, you will receive the following benefits:
- Cover related to medical practitioner costs
- Cover related to the cost of co-payments or deductibles charged by your medical aid. (Subject to some exclusions)
- Cover related to the cost of co-payments when it comes to cancer treatments.
- Cover related to the cost of cancer treatments once you have exceeded your medical aid limit in this regard
- A once-off lump sum that is paid out if cancer is diagnosed
- Cover related to the cost of internal prosthesis
- A lump sum that is paid out if you are hospitalized over the long-term.
- Accidental death cover
- Cover for total, permanent disability
- A set benefit for dentistry if necessary as a result of an accident
- Cover related to the cost of visits to the emergency room
Admed Gap Cover for Primary Medical Aid Members Includes
If you want something that is a bit more basic, you can choose the Admed Primary Gap cover.
You will receive the following:
- Cover related to medical practitioner costs
- Cover related to the cost of co-payments or deductibles charged by your medical aid. (Subject to some exclusions)
Do I Qualify for Cover?
To be able to apply, you must currently be a member in good standing of a medical aid scheme in South Africa.
Final Thoughts
Gap cover is intended to help you when it comes to paying the difference between what your medical aid pays and what you are charged. It is not a replacement for medical aid but rather an enhancement to it.
Gap cover can be a valuable tool when it comes to financial planning going forward.
When you, or someone you love, needs professional care, you do not want to have to worry about costs. Gap cover is affordable and can give you peace of mind when you need it most.
Get a FREE medical gap cover quote if you are on a medical aid. Complete and send the form on this page
All info was correct at time of publishing