Gap Cover for Topmed Has Got You Covered
December 10, 2021
Look into Gap cover for Topmed as most South Africans have made a very costly mistake when it comes to medical aid cover.
Having an operation and staying in a hospital for a few days is no problem because you have an excellent medical aid, right?
Wrong. When you receive a bill for the shortfall, you could be in deep financial trouble. Think it can’t happen to you? It can. You need gap cover for Topmed if you are on that medical scheme.
Gap Cover for Topmed makes Sure it won’t Happen to You.
Jane never thought it could happen to her. She went in for a relatively routine operation and stayed overnight in the hospital. She has 100% cover, so she didn’t worry about the bill.
Her medical plan did pay 100% of the medical aid rates. However, what she found out later, was that the surgeon who did the operation charged well-above medical aid rates.
That left her with a shortfall of R11 494 to pay out of pocket. She learned a very expensive lesson.
Does Jane think Gap Cover Insurance is Necessary?
Before this incident, Jane had no idea what gap insurance cover was. She has since learned that if she had had one of these policies in place, she would not have had to find the R11 494.
That’s because gap cover makes good the difference between standard medical aid rates and the specialist’s fees.
Medical gap cover is not something that you “should” have especially if the budget is tight. Unless you have access to thousands Rands, it is essential.
The statistics are scary – specialists often charge at least double what the medical aid rates are. That leaves you liable for at least as much as what your medical aid paid.
The specialists and hospitals can set their fee structures. Some charge as much as 400% over medical aid rates.
For less than what you would pay for your monthly coffee bill, you can protect yourself against these potential fees. Isn’t the peace of mind worth it?
So do I Qualify? Yes, if You are –
- Currently a member of a South African registered medical aid.
- A dependent of the primary member and enjoy the same level of cover.
- Not 61 or older.
Do I get Cover Straight Away?
As with most insurance products, waiting periods exist before you can claim:
- You cannot make any claims at all in the first three months.
- Claims related to pre-existing conditions, such as heart disease, will not be paid out in the first year.
- A waiting period of a year for claims related to pregnancy.
What Exclusions are There?
- Surgery to treat obesity.
- Cosmetic surgery that is not trauma or disease-related.
- Co-payments of a changeable amount – for example when charged a percentage of the sum and not a set cost.
- Cases where the excess is as a result of proper authorization procedures not being followed by you.
- Dentistry that is not related to tumours/cancers or trauma.
- Claims not handed in timeously within a six months period.
To get a FREE medical gap cover quote, just complete and send the form on this page
All info was correct at time of publishing