Answers to Your Medical Gap Cover Questions

    It is not unreasonable that South Africans who have medical aid cover dig in their heels at the thought of paying, even more, money every month for medical gap cover. Why should they when their medical aid premiums take a hefty chunk out of their monthly financial commitments? The answer is simple. No matter how much it hurts household purse-strings, medical gap cover has become an essential monthly expense to safeguard families against exorbitant additional medical costs. Many people believe they have full cover because their medical schemes state that they pay 100% of hospital bills. They are not lying, but the truth is that medical schemes only pay 100% of prescribed medical rates. The medical profession, on the other hand, is free to charge whatever fees it likes for their expertise. It is for this reason that more often than not when people end up in the hospital the medical costs that far outstrip their medical aid tariff limits. They are then personally responsible for settling the balance of the hospital costs. Continue to read on for more questions and answers about gap cover.

    Why buy Gap Cover – Questions about gap cover

    It covers the difference between medical aid tariffs and the amounts charged for hospitalisation. These costs can sometimes be five times more than the ceilings imposed by medical schemes.

    Who Qualifies for Gap Cover –  Questions about gap cover

    QuestionsAll members of a registered medical scheme qualify for Gap Cover. This includes the principal member as well as the spouse or life partner and children.

    Does Gap Cover Have a Direct Link to a Medical Scheme? Gap Cover does not have a direct link to any particular medical scheme. It is a separate short-term insurance policy that you use in conjunction with any medical scheme.

    What Happens When a Policy Holder changes Medical Schemes? Gap Cover continues to operate, provided that medical scheme members keep their monthly payments up to date.

    Who Provides Gap Cover? There are many South African companies that offer this form of protection, including household names such as Sanlam, Bonitas and Discovery.

    How Much Extra Does Gap Cover Cost? They regard gap cover as one of the most affordable products available to safeguard the finances of medical aid members. Monthly premiums vary, depending on the cover selected, but Gap Cover can be provided for around R200 monthly per family.

    Does Gap Cover Pay Everything That Medical Schemes Do Not? There are some medical procedures that gap cover does not cover These include suicides, mental, disorders, obesity, cosmetic surgery and specialised dentistry.

    What About Medical Co-Payments for Medical Aid? Gap Cover does not ensure policyholders for Co-Payments UNLESS this benefit is added to the policy at an additional monthly premium.

    When Does Medical Gap Cover Commence? This form of insurance begins as soon as you pay the first monthly premium.

    Are There Waiting Periods for Gap Cover? Underwriters impose waiting periods for pre-existing conditions. Policies could also include other limitations.

    What About Gap Cover and New Additions to the Family? Babies can be added to the policy, provided they are registered within 30 days of birth. Also, the policy must have been in operation for at least three months.

    Read the fine print – Questions about gap cover

    Consumers are urged to read the fine print of policies before committing themselves to any one company. They are also strongly advised to investigate all options to make an informed decision that will suit their lifestyles and budgets. Also, the advice of a broker could go a long way in helping them to reach that final decision.  

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