Guardrisk is a registered South African insurer and offers its clients medical gap cover, known as Admed, which is tailored to meet individual needs, as well as access to loads of additional benefits.
As most members of medical schemes now know, they are not fully covered for specified treatments and procedures because members of the medical profession impose fees way above the tariff rates stipulated by the schemes. Admed is a gap cover product that pays in the difference between medical scheme tariff rates and private practice fees.
Admed covers the shortfalls of in-hospital surgeries and treatments, as well as for stipulated outpatient procedures.
Example of shortfalls
As an example, some medical aid schemes may pay 100% of their stipulated tariff rates as dictated by the National Health Reference Price List (NHRPL). However, it is a known fact that the private medical fraternity is not regulated by any government agency and can charge what it likes for its services. In fact, it has become common practice for the private medical sector to impose fees that are five times higher than the NHRPL. That huge difference in price must then be settled by the medical scheme member.
Who qualifies for Guardrisk Admed gap cover?
To qualify for Admed gap cover the following requirements must be met:
- Applicants must be no more than 65 years of age
- Applicants must belong to a registered South African medical scheme
Are there waiting periods?
- There is a three-month waiting period after signing for Admed gap cover
- Exceptions can be made in emergency situations
- Maternity benefits are subject to a 12-month waiting period
- 12-month waiting periods also apply to applicants with pre-existing medical conditions
What does Admed gap cover cost?
- Supreme Gap is for families below the age of 65 years and costs R309 monthly
- Supreme Pensioner Gap costs R499 monthly
What benefits does Admed offer?
- Shortfall benefits are limited to R150 000 per person annually
- Co-payments and deductibles apply to ultrasound and to MRI and CAT scans
- It also covers co-payments for oncology treatments for clients registered with their medical scheme for cancer care
- It pays up to R30 00 per policy annually for internal prosthesis procedures
- It pays an accident benefit of up to R10 000 per policy annually for emergency treatments
- Lump Sum Benefits (There is no maximum limit to these benefits)
- R15 000 for first-time cancer diagnosis
- R50 000 in the event of the death or total disability
- R750 a session, limited to R25 000 annually per family, for trauma counselling
Conclusion
Guardrisk is a well-established and respected insurance provider whose gap cover products have been streamlined to suit the South African lifestyle and whose premiums ensure affordability and stability of service provision.
To receive your gap cover quote today, merely provide the details in the form on this page and a consultant will contact you.