Medical Cover – Are You Over-Insured?

December 9, 2021

In South Africa today you need several types of medical cover to make sure you are prepared for all eventualities.

If you belong to a medical aid scheme and someone offers you gap cover you may think that would be too much insurance.

But in South Africa, this is not the case. We live in a society with rampant crime and below standard service delivery. So anything can happen. And it does!

South African medical aid scheme members can apply for a gap cover quote NOW. Just complete and sending the form on this page

Each of the Variety of Products Offered Serve a different Purpose –

  • Medical Aid Cover

A comprehensive medical aid scheme option insures 100% of your eMedical Coverxpenses for your in-hospital stay.

Other kinds of medical aid depend on what option plan you have selected. You might be on a hospital plan, or you might have cover for in and out of hospital expenses.

Within the benefit limits offered by your scheme, you will be compensated for your actual medical expenses. The insurance company will pay compensation to you, the member. Then you pay the service provider (hospital or doctor).

Because specialists can charge what they want, you need gap cover. That is if you don’t want to pay for the amount that your medical aid doesn’t cover.

  • Gap Cover

Gap cover is the difference between the rate that your medical scheme compensates you and the rates that the specialists who attended you will charge for your hospital treatment.

Even if you do belong to the top plan of your medical aid scheme, the medical rate can still turn out to be lower than what the specialist’s fee turns out to be. That is the shortfall, and you will be responsible for settling that outstanding amount.

Many people wrongfully assume that if their medical aid scheme covers 100% of the hospital fees, then that is the end of your financial commitments. That is not the case.

You might be in for a shock when you discover what the shortfall could be and you need to prepare for this. The insurance you take out for this is called gap cover.

  • Medical Insurance

Another type of insurance is medical insurance. This policy is a long-term one. You will pay a premium every month for this.

In return, the medical insurance company will pay you a predetermined amount if you are the life insured and a particular ‘health accident or health event’ occurs.

Even if you as the policyholder did not incur any expenses in this event, the benefit is usually paid out to the insured and not to the service provider. This medical cover is meant to pay for expenses such as loss of earnings, school fees and groceries.

It is Highly Unlikely you will be Over-Insured

Unfortunately, the older we get, the more likely we are at some time to become seriously ill, and this will also most probably hospitalise us.

That is going to be a very costly business, and if you do not have medical cover for this, you might find yourself in dire financial straits. This kind of medical expense is such that you may never recover.

Not everything will be covered by your medical aid scheme. It is vital that you invest in gap cover and be prepared for any shortfalls that can indeed happen between what your medical scheme’s tariff is and what your specialist’s tariff is.

They are ALL Beneficial

There are differences between medical aid schemes, gap cover and medical insurance.

If you have a medical aid that you belong to and have not considered taking out gap cover or medical insurance cover because you think that would be too much cover, think again.

Each type of medical cover is different and serves a very necessary part to ensure you aren’t financially bereft.

South African medical aid scheme members can apply for a personal gap cover quote NOW. Just complete and sending the form on this page


All info was correct at time of publishing