How a Gap Policy Works

December 11, 2021

Why did your medical aid did not cover all of your costs when you were in a hospital? And even when you knew you had 100 percent cover? Now is the time to find out about gap cover and consider getting a gap policy.

All medical aid policies have masses of small print. And this is where problems arise for clients looking for straightforward cover and peace of mind.

You want to know that if you pay your premiums, you have total cover for medical expenses.

Unfortunately, the average person only finds out about large expenses not being paid too late. This is why gap cover is helpful.

Medical aid members can apply for your personal medical gap cover quote. Just complete then submit the form on this page

gap policyWhat is a Gap Policy?

Whatever medical aid plan you belong to, Momentum Health or any other medical aid plan, each scheme will have a large number of exception to the cover they offer.

Costs and limits on those costs will also vary from plan to plan and gap cover can help to deal with the exceptions to cover detailed in your main plan.

A gap policy can be found with some providers, at different costs and the providers include:

Choose your gap cover carefully; make sure you find out exactly what gaps it offers to cover and how it will help you when your main medical aid plan fails to pay out 100 percent of your treatment costs.

What Does Gap Insurance Cover? Follow this as an example of how gap cover can help –

Imagine a GEMS medical aid policy offers 100 percent or even 200 percent of hospital costs.

Unfortunately, specialist doctors are not regulated in their charges so they might charge more than even the 200 percent. This means you pay the balance out of your pocket.

Gap cover is a way of providing insurance to cover those shortfalls not met by our primary medical aid plan.

So, if you are thinking about getting a gap policy, you need to understand it is not part of your medical plan and is not even covered by the same legal requirements.

It is a valuable policy to have in place, even if you belong to a scheme that is generous and pays out at even 300 percent.

Your gap policy will also refund to you directly and not your hospital. Online quotes are the best way to find out the best deals available.

How does Gap Cover Work?

Claims made under gap insurance are separate from the claims made under your main medical aid plan and need submitting after the main bill has been paid.

It is also the way to go forward because with gap cover in place you can safely downgrade your main medical insurance and save money.

Find out more about how gap cover can help by completing the form, and we’ll get a gap cover specialist to talk to you in detail.

Medical aid members can apply for a medical gap cover quote by completing and sending the form on this page

All info was correct at time of publishing