Intelligent health cover in South Africa includes gap insurance

    April 19, 2020

    If you are an intelligent South African, you will probably have a solid medical aid plan and perhaps some health insurance too.

    But did you know that these kinds of insurance might not be enough. That’s because

    1. medical aid does not necessarily cover the entire cost of a hospital stay and specialist care, let alone oncology treatment, resulting in patient co-payments
    2. health insurance, such as offered by companies like Clientele, do not relate to actual hospital and specialist bills, with the company paying out just a small cash amount for day-to-day costs

    What is the intelligent solution?

    An aspect of health cover in South Africa that even smat, well-educated people forget to insure the gap between real health costs and what your medical aid will pay.

    In other words, they fail to insure the shortfall, the top-up amount or the gap. They simply omit to take out gap cover, which is absolutely vital nowadays.

    How it works and why it is necessary

    Let us say you or a family member has to have an operation in hospital. And let’s assume the bill amounts to R120 000.

    If you have a medical aid plan that pays out 100% you might think you will not have to pay anything.

    Unfortunately that is not the case. The “100%: refers to the amount that appears in the Medical Aid Tariff list, which the medical schemes use internally.

    So the medical aid might agree to pay R90 000 of your bill, for instance, leaving you to find the R30 000 in cash to pay the shortfall.

    The same applies to plans offering 200%, 300% and 400%. That is because hospitals and specialists can charge 500% up to 800% of the amounts in the tarriff tables.

    The solution: gap cover takes care of the shortfall, paying out the shortfall in cash into your account for you to settle your bills.

    So make the bright choice. If you belong to a registered medical aid in South Africa, use the contact box on this page so we can get a gap cover quote to you fast.

    All info was correct at time of publishing