Medical Shortfall Insurance for Selfmed Members
December 12, 2021
Gap cover is essential to protect medical aid members of Selfmed for unexpected health care needs. Any insurance company that offers gap cover can provide medical shortfall insurance for Selfmed members.
Why?
Specialists and hospitals are not legally obliged to charge Recommended or Standard Medical Aid rates.
In fact, their bills are often up to five times higher than the medical aid rates stipulated by medical scheme companies!
That is when Gap cover kicks in; it pays the difference between the recommended tariffs and the final bill imposed by the health care industry.
Confused?
Medical Aid holders must read the fine print of their contract very carefully.
That is because members often misinterpret their medical scheme contracts.
Perhaps the contract reads that the medical scheme will cover 100% of hospital costs. But that applies to the recommended tariffs and, as explained earlier, medical practitioners and hospitals are not legally bound to adhere to that payment scale.
So when the medical scheme member receives bills up to five times more than the recommended tariff, he/she must pay the excess!
And that is when Gap cover kicks in.
Who Qualifies?
That is medical shortfall insurance for Selfmed members and all other medical aid schemes.
What is Gap Cover?
Gap cover is short-term insurance to cover shortfalls of what the medical scheme pays and the fees imposed by the medical industry. Gap cover pays the difference, giving policyholders peace of mind by avoiding unexpected and hefty additional costs.
Do You Need Medical Shortfall Insurance for Selfmed?
The costs involved with hospitalisation can be exorbitant.
Accidents happen as do emergency health care needs.
Without Gap cover, must medical aid members cannot afford to pay the difference between what their medical schemes cover and the charges billed by specialists and hospitals.
What does Gap Cover Cost?
That depends on the cover selected.
Basic options only offer cover for emergency health expenses.
The comprehensive cover will pay for specialised dental treatments as well as dread diseases such as cancer.
The cost of Gap cover relates to the type of policy selected, and Selfmed medical scheme members should carefully weigh up their options to best suit their lifestyles and budgets.
Are There Waiting Periods?
Yes.
Waiting periods differ, depending on the regulations stipulated by the medical scheme.
However, the typical waiting period is three months.
Members with pre-existing conditions will have to wait for longer periods before qualifying for Gap cover. These waiting periods vary, depending on the company.
A waiting period of one year is also generally imposed before Gap will cover additional expenses involved with pregnancies.
Are There Exclusions?
Most companies will not supply gap cover to people older than 65 years.
It is, therefore, important to study what medical schemes have on offer and to carefully study their exclusion policies.
Claims
According to South African law, the insurance company will pay gap cover claims directly to the policyholder and not to the service provider.
Conclusion
Most people regard Gap cover as a non-essential form of insurance or even as a luxury item. But the ever increasing cost of medical health care is reinforcing the need for South Africans to consider adding this type of insurance to their portfolios seriously.
Gap cover is not superfluous.
Gap cover is essential to protect medical scheme policyholders from financially crippling and unforeseen additional costs.
Medical shortfall insurance for Selfmed is an essential short-term insurance policy to protect the medical welfare of all Selfmed members and their families.
To get a free gap cover quote, please complete and send the short form
All info was correct at time of publishing