Medical Gap Cover Waiting Period

    Short term insurance will offer to cover the shortfall between what Medical Aid societies will pay out and what the medical practitioners and health care facilities will charge. Continue to read on to find out more about the medical gap cover waiting period.

    Will I receive immediate cover for any eventuality – Medical gap cover waiting period

    The short answer to this is that it depends on the type of policy selected. Each policy has its own list of exclusions and restrictions. When you select a policy, you need to look carefully at this.

    Medical gap cover waiting periodImportant notes

    • Amongst the most asked question about exclusions and restrictions is whether the cover is available immediately. In most instances, there is a general waiting period of three months, but there are some exceptions to this.
    • In instances where a policy imposes a waiting period, this means that the new member may not claim during the initial waiting period. If you require an emergency procedure, you will not have any cover.

    Why do Gap Insurers do this – Medical gap cover waiting period

    medical gap cover waiting periodThis is to stop new members to join, to protect themselves from an immediate claim.

    The three months waiting period may not be the only waiting restriction imposed.

    Many Gap Insurers also have a maternity waiting period, while others have a restrictive percentage for claims on certain procedures or a phased-in implementation.

    Why do they this?

    Although it might seem unfair that new members have no cover in this time, the companies have a reason for this. Purely on the basis that the Insurance Companies wish to protect their interests.

    Fortunately, there are a few Companies now offering Gap Cover without the initial waiting period.

    These policies offer new members the comfort of cover from day one, while the restrict certain major procedures.

    This does seem a more equitable way of doing things, offering a win-win for both parties.

    Zestlife were at the forefront of this and will offer Gap Cover with immediate effect for new members. To achieve this, there is some exclusion:

    • There is also a twelve month wait period for maternity claims.
    • Certain surgical procedures are on a twelve month waiting period. This incorporates such procedures as:
    • Joint replacements, spinal surgery and arthroscopic procedures.
    • Nasal and cataract surgery, hysterectomies, unless cancerous.
    • A hernia and cardiac surgery.
    • Pre-existing ailments or conditions that were known or diagnosed within a 12 month period before membership are excluded from the immediate claim and are subject to a 12 month waiting period.
    • Waiting periods on these exclusions may be waivered should they be as a result of an accident, after the cover has commenced.

    Changes in new regulations in the near future.

    Regulations governing “Gap” Insurance were published late 2016, and are expected to be implemented in April 2017. Many Insurers are in the process of re-structuring their policies to align them with expected regulations, the waiting period for new policy holders will change. You can rest easy, for this will not have any effect on your policies until January 2018.

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