Lower Your Medical Costs This Way

December 11, 2021

Just because you want to lower your medical costs does not mean you have to reduce your cover.

Here is a way to pay less for medical aid while actually increasing your health insurance profile.

An Example of a Financial Health Predicament

Let’s say you have a strong medical aid plan that costs your family R6 000 a month.

However, the plan means you have cover for 300% of the medical scheme tariff.

So if you land up in hospital and need specialist or high care, you could be in a financial pickle.

That is because specialists and hospitals often pay as much as 600% or 900% of the medical scheme tariff.

That could stick you with high bills that you would have to pay out of your own pocket.

Assume there is a combined hospital and specialist bill of R120 000 (and that’s an amount that’s easy to run up these days).

And let’s assume the medical scheme tariffs amount to a combined R25 000 for these. The medical aid would then agree to pay R75 000 of the bill.

Unfortunately, you would then have to pay a hefty R45 000 out of your own pocket.

How to Lower or Even Eliminate These Co-Payments

There is away to insure yourself against copayments.

It’s called gap cover, shortfall cover or top-up cover.

And there is a clever way to even lower your total premium cost using gap cover, while increasing your total medical cost security.

You would have to do your own sums, but it’s entirely possible to opt for a lower-cost medical plan (such as merely a hospital plan from your medical aid) combined with gap cover.

The total could actually be lower than your previous medical aid premium.

A monthly gap cover premium typicall equates to 5% to 10% of your medical aid premium.

Taking the above example, say you take out a cheaper plan for R4500 a month with 200% cover.

Then you add gap cover for, say, R600 a month.

You are paying R5100 only (as opposed to R6000 previously) plus you now have the security of covering your co-payments.


Complete and submit the form on this page to contact us. We will return with a quote and help you sign up for gap cover. (P.S. You must be a member of a registered medical scheme to qualify for gap cover. Check here to see if your medical cover complies.)


All info was correct at time of publishing