Gap Cover for Sizwe Medical Scheme

December 17, 2021

Consider gap cover for Sizwe Medical Scheme when it comes to medical expenses. There is often a shortfall, or gap, between the amount the medical aid pays and the amount the doctor’s charge.

These gaps in cover can be quite significant because health practitioners can set their rates at whatever level suits them.

Their fees are often double or even triple the amount insured by most policies.

The gap is often most significant when it comes to hospitalisation and in-hospital expenses. The extra cost catches patients unawares as they believe their medical aid covers everything.

Gap Cover for Sizwe Medical Scheme

Sizwe has come up with gap cover that can help with this. This cover is available to those on the Full Budget Plan and will pay out up to three times the standard Sizwe rate.

The cover is designed to prevent you from having to pay out of pocket when doctors or specialists have charged more than the rate covered by the Sizwe Medical Scheme.

Gap Cover for Sizwe Medical Scheme

Is cover Automatic?

Only clients on the Full Budget Plan are eligible. You have to submit a separate claim to have the extra amount paid out.

Do I Pay in advance at Hospital?

Sizwe Medical Scheme does not require that members pay any advance fees. However, you do need to get authorization for hospitalisation upfront.

What if I am on the Primary or Affordable Plan?

If you are on either of these plans, then normal Sizwe Medical rates apply, You are, however, able to apply for gap cover from another insurance provider if you would like to. The medical aid and gap cover can run independently of one another.

How do I Know what I must Pay?

It is advisable to check with your doctor what their rates are upfront. You can then check this against the rates that the Sizwe Medical Scheme will pay.

If you are unsure of whether or not your policy covers the full amount, contact Sizwe Medical Scheme directly to check.

Do I Really Need to Think About Gap Cover?

A tight budget might tempt you to think that gap cover is not really necessary. That could cost you very dearly in the long run, though.

You can find gap cover from as little as R55 per month so there will be a plan out there that will suit your current budget.

Think about it this way – you want to be able to have the best possible care in a medical emergency and that might mean paying more than what your medical aid will cover.

Don’t settle for a second-rate provider? Would you rather put yourself at risk of paying extremely expensive shortfalls? Don’t you want the best for your family as well?

At the end of the day, only you can make the decision about whether or not gap cover is right for you.

Considering the alternatives, though, gap cover for Sizwe Medical Scheme seems a small price to pay for peace of mind.

Only Medical aid members can apply for a FREE medical gap cover quote. Complete and send the form on this page.

All info was correct at time of publishing