Medical Scheme Members Also Need Medical Gap Cover!

December 16, 2021

In our fast-paced lives, medical scheme members often skim over details that can have a huge impact in our future, like neglecting to read the fine-print in documents before putting pen to paper.

Nothing could be truer than our failure to read and understand exactly what our medical aid scheme benefits do and don’t offer, a short-sighted mistake that can end up costing us dearly.

Medical schemes can purport to pay out up to three times more than their basic standard tariff rates but these, nevertheless, will fall way short of what medical practitioners are likely to charge for their services. Today, it is not uncommon for the medical profession to charge up to 600 per cent more for their services than the prescribed Medical Scheme Tariff (MST).

So, whether you are injured at work, are involved in an accident or suddenly need an emergency operation, your medical aid is unlikely to fully meet the cost of the final charges imposed by your medical practitioners.

Medical Scheme Members and Gap Cover

That is where Gap Cover enters the fray. This short-term insurance policy is nothing more than a top-up scheme, not unlike that offered with car insurance, that pays in the difference between the MST and the charges imposed by the medical professionals who are free to dictate whatever fees they choose.

Without gap cover, you are exposing yourself to a can of worms that will erode your financial stability.

Avoid the after-shock of unforeseen medical bills

So, do yourself and those who are near and dear a favour and invest in a gap cover short-term insurance policy. It’s affordable and will take all the stress of coming up short-changed out of your life. Here’s agrim reminder of what could happen without gap cover.

  • Example

Your wife goes into labour and is rushed to the hospital. Her natural birth procedure could cost in excess of R19,000 if there are no complications. You believe that your medical aid will foot the bill and are not prepared for the after-shock when discovering that the scheme will only pay R9,000, leaving you with a R10,000 shortfall. If you have gap cover you can sleep easy because your policy will pay the full outstanding amount.

Medical Scheme Members

This example clearly indicates why medical aid members need gap cover. Don’t be pennywise and pound foolish because, in reality, gap cover is affordable and insures your financial wellbeing when it comes to the healthcare ofyour family.

Who qualifies for gap cover?

Only members of a registered South African medical aid scheme qualify for gap cover. This form of short-term insurance is not a medical aid scheme but rather a top-up policy that pays the difference between your medical aid’s prescribed tariff rates and the amounts charged by members of the medical practice.

Another attraction is that you are not compelled to take out gap cover through your medical aid scheme. You can pick and choose a gap cover provider that best suits your needs. For instance, you may be a medical aid member of Genesis or Medshield but decide that Discovery offers you the best gap cover to suit your medical needs and financial constraints.

Other attractions are gap cover of up to five times higher than those offered by your medical scheme and co-payment cover for hospital and outpatient treatments that can save you up to R20,000.

Do your research and then complete the form on this page to receive your Zestlife medical gap cover quote.

All info was correct at time of publishing