Guardrisk Medical Gap Cover for Medical Aid Members in South Africa
Admed Medical Shortfall Cover by Guardrisk
Admed Medical Shortfall Cover is specifically designed by Guardrisk to bridge the financial shortfalls for surgeries and medical treatments while in the hospital. Here we will look at Guardrisk medical gap cover.
So it will pay up to twice the amount stipulated my medical schemes.
The amount payable, however, will not exceed the amount of the Gap between the medical aid’s recommended tariff and the final accounts imposed by the medical profession.
So it is important to note that Admed’s Medical Shortfall Cover does not act as a replacement for medical aid cover or cover shortfalls between charges imposed by doctors and payment ceilings imposed by medical schemes.
It will pay up to twice the amount allocated by medical aids towards the shortfall, but not exceeding the amount of the Gap.
The Gap Cover offered by Admed to policyholders also applies to specified out-patient procedures.
Guardrisk Medical Gap Cover
There are two Gap Cover products on offer from Admed.
The Supreme Gap comprehensive benefits include:
- Medical practitioner costs, These are the shortfalls between medical aid cover and charges by the medical practitioners. It also includes Prescribed Minimum Benefits
- Co-payments or deductibles imposed by medical schemes for various procedures
- Co-payments for oncology treatments levied by medical schemes
- Ongoing oncology treatment costs once medical scheme benefit ceilings exceed.
- First-time cancer diagnosis lump sum benefits
- Internal prosthesis shortfalls
- Benefits for accidental death and permanent total disabilities
- Long-term hospital stay lump sum benefits
- Benefits for dental procedures resulting from accidental injury
- Casualty visit costs
Admed’s Primary Gap Cover – Guardrisk Medical Gap Cover
- Shortfalls are arising when medical practitioner costs exceed medical aid cover. Prescribed Minimum Benefits do not have cover.
- Co-payments and deductibles fees imposed by medical schemes for certain procedures.
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