Gap Cover and its Legal Standing

December 1, 2024

Gap cover is not the same as a medical aid or an alternative to is. The design of this insurance is to complement your existing medical aid fund. Due to the confusion regarding what gap cover is and its purpose. They were on the verge to declare gap cover as illegal medical insurance. However, new legislation is already in action in 2017 to clear up this confusion. In this article, we will discuss the current legal standing of gap cover.

Continued Operation: Legal Standing

One of the first and most important things you need to know about the new regulations implemented on gap cover is that it allows gap cover policies to continue operating. Without these new strict rules, gap cover policies would have ceased to exist. Many factors contribute to this decision, and the most important thing to know is that you can still use gap cover. Despite the changes, they have made.

Payout Limits

Gap cover policies may only pay amounts out up to R150 000 per client per annum. Experts also believe that medical specialist often charges higher rates since they know a patients gap cover will pay out beyond their medical aid scheme. This will also prevent the limitation on payout amounts and increase competition in the medical field regarding costs. The cap on gap cover will increase by CPI every year.

Age Limits

Before the new legislation was brought into effect, the maximum age of entry for gap cover was 65 years of age. After that, you couldn’t get gap cover. With the exclusions now being removed, a lot of people will be benefitting.

“Before you couldn’t get gap cover after the age of 65. Regulations now remove that exclusion.”— Paresh Prema (Head of the Medical Benefits Management Unit)

They Will Expand Their Cover 

The new regulations have now expanded gap cover coverage to certain cancers not covered by medical aid schemes at all. Although gap cover usually has cover for specialised health problems. Which medical aids did not cover, this newly expanded field of coverage is a huge added benefit since a health issue not covered by medical schemes at all will know be paid for!

Conclusion to the legal standing of gap cover

Although some may see these new changes regarding the legal standing of gap cover as an inconvenience, in the long run, they will be greatly benefitted from. Make sure that your medical gap cover provider explains these new changes to you in depth and ask all necessary questions to ensure that you understand these new laws regarding gap cover fully.

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All info was correct at time of publishing