Understanding Your Liberty Universal Gap Cover Policy
November 26, 2018
We intend to inform you how your Liberty Universal gap cover policy works and what you can expect.
Your medical gap cover is not a medical aid or a medical scheme but an insurance policy that covers all the dependents on the main member’s medical scheme, with the exception of multiple spouses.
Medical schemes set the amount that they will pay for each and every treatment they will cover. That is the Medical Scheme Tariff or MST.
Your medical scheme will pay 100%, 150% or even 200% of the MST, depending on the medical aid option you have chosen.
When being treated, however, surgeons, anaesthetists and other medical specialists are free to charge whatever they like, with the result that they frequently do. And they charge substantially more than the MST.
A Universal Gap Cover Policy from Liberty takes care of this unplanned shortfall.
Liberty Universal Gap Cover Policy – An Example to Illustrate the Point
Michelle is hospitalised for a routine appendix operation. The procedure is performed without complications, and she is in and out of the hospital in two days. She is not expecting any surprises as she is on a medical aid option that pays 100%.
But Michelle has a problem.
While her medical scheme will pay 100% of a pre-determined tariff (the MST) her doctor charges a completely different rate.
She opens a bill which reads: “General Surgeon’s fees: R10 200.38, Anaesthetist R7 544.00, Total Charge R17 744.38”. It further states that the medical scheme tariff at 100% is a total of R7247.75.
That leaves Michelle with a bill of R10 496.63 that she must pay out of her own pocket to settle the anaesthetist and surgeon.
A Liberty Universal Gap Cover policy takes care of this shortfall. That is the unpaid amount that your Universal Gap Cover policy covers. Once you put in your claim, Liberty will pay the shortfall up to five times the MST with no maximum claim limit.
Medical Expense Shortfall Cover
Universal Gap Cover includes benefits such as:
- In-hospital cover for doctor and specialist charges up to 5 times the medical scheme tariff.
- Out-of-hospital cover for doctor and specialist charges up to 5 times the medical scheme tariff for approximately 50 out-of-hospital treatments.
- Medical scheme co-payment cover for hospital admissions, scans and certain surgical procedures.
- Emergency Room Cover for accidental injury.
- In addition to the above, Liberty Universal Gap Cover also includes: Non-network Co-payment Cover, Enhanced Cancer Cover, Internal Prosthesis and Artificial Joint Cover as well as In-hospital Dentistry Cover.
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All info was correct at time of publishing