MedCare Gap Cover Steps in when Medical Schemes Step Out

December 9, 2021

The MedCare gap cover range of products has been exclusively designed for members of South African medical aid schemes who need top-up insurance to cover the additional costs imposed by the private medical sector for various procedures and treatments. MedCare can help!

With MedCare gap cover, policyholders can enjoy up to 500% over-and-above the tariff rates paid by their medical schemes. For example, an anaesthetist could charge way above the R1 200 for a tonsillectomy procedure’s prescribed tariff paid by your medical aid but a MedCare gap product will cover you for up to R6 000 on any shortfall.

MedCare offers a wide range of gap cover products to suit individual needs and budgetary requirements and is provided by Medway, a leading South African healthcare advisor that began operating back in 1990.

Understanding the gap

Gap cover is a form of short-term insurance that was created to fill the gap between medical schemes tariff rates and those charged by the private medical sector. Medical schemes are government-controlled, unlike the medical profession which can charge consumers what they like for their services. In recent years, the gap between medical scheme pay-outs and the charges imposed by medical practitioners and private hospitals has escalated beyond the financial means of the ordinary man-in-the-street. So much so, that untold numbers of South Africans are facing medical costs of up to 600% percent more than what their medical schemes will pay.

Although regarded as an additional optional extra, gap cover is no longer a luxury but an absolute essential for your financial peace of mind.

Depending on individual needs and finances, MedCare offers a selection of gap cover products for certain hospital procedures and treatments, as well as other financial drains such as co-payments and sub-limits. Consumers can choose from GapCore, GapXtra and GapPremium, all of which cover families for up to R150 000 annually.

GapCore

Cover starts from a very affordable R275 monthly for members of a registered medical scheme. This basic GapCore covers policyholders for up to 500% above their medical scheme tariff rate for in-hospital procedures. It also includes cover for out-patient treatments such as chemotherapy, kidney dialysis and radiotherapy. Prescribed procedures performed in-house by doctors are also covered. It also offers a R10 000 accidental injury benefit.

GapXtra

GapXtra costs R305 a month and, apart from all the above-mentioned benefits, also includes sub-limit payments for in-hospital prescribed procedures.

GapPremium

GapPremium costs R350 a month and offers an additional payment of up to R10 000 for accidental injury.

MedCare GapPremium Plus

Top-of-the-range is Gap Premium Plus that costs R410 a month. This includes all of the above-mentioned benefits plus the all-important cover for cancer. These oncology benefits will pay out additional fees associated with sub-limits and co-payments imposed by medical schemes for treatment, in-hospital expenses, chemicals and medication, as well as out-patient chemotherapy and radiotherapy treatments. It also covers any shortfalls in the cost for biological cancer drug treatments once medical scheme oncology limits have been reached.

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All info was correct at time of publishing