Gaps in Medical Scheme Cover

December 18, 2021

As is the case with any policy, there will be specified areas that have cover and other parts with no cover. So there are some gaps in medical scheme cover.

So tt is an impossible feat for an insurance company to assist coverage for all the areas of life, in one single policy.

Here are ten gaps in medical scheme cover:


Health charges surpasses the aid’s available funds

Gaps in Medical Scheme CoverIn any policy, you will have a set limit of available funds.

Your funds will be determined by your monthly instalments, as well as the benefits of the aid you have selected.

Medical aid will never fully cover your medical charges, resulting in you paying for the excess amounts.


Medical aids pay lower fees than doctors charge

The aid determines the costs they will cover from a list of fixed medicinal prices.

This list does not limit medical professionals.

Also, the list is used as a guideline and does not require any health provider to abide by it.

For this reason, there is an excess after your medical bill has already deducted your scheme’s funds.


Not compensating for the set minimum aid

There is a set minimum assistance that has been initiated.

This support consists of health scenarios and conditions that must be treated, due to its life-threatening impact.

Some schemes may unfortunately not compensate you for these.

You need to make sure that you provide all the necessary documentation, to receive the aid you require.


Limitations in prescribed therapeutic processes

The aid has pre-determined rules for certain medical treatments in place.

Your health practitioner may prescribe a different method.

It will cause only a partial payout or simply be rejected by your scheme.

Additional charges – Gaps in Medical Scheme Cover

Within the scheme, they have specified terms and conditions of medicinal procedures they cover.

If you go another route and make use of alternatives, there will be additional charges and extra subtractions from your monthly premiums.


Limitations in assisting cancer treatments

Cancer treatments require a lot of processes that is extremely costly.

Your aid will only be able to manage to assist you to some extent.


Insufficient medicinal money reserves

Most medical aids require you to make use of an account wherein you save a certain percentage monthly.

So it’s the only account you can implement daily.


Restrictions on prosthetics and external supportive equipment

Providing in prosthetics and supporting equipment is a restriction.

These requirements might get partial coverage but will not receive full financial assistance from your aid.


Coverage prohibitions

Waiting periods for certain health issues are irrevocable.

The event of an injury, due to taking part in a risky venture, will ultimately result in you not receiving any financial aid.


Extended recovery processes

You can receive aid for a short-term recovery process.

If your recovery requires a longer period, however, your aid will not be able to assist you.


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All info was correct at time of publishing