Do I Really Need Medical Gap Cover?

December 19, 2021

You might ask yourself “Do I really need medical gap cover?”

  • Yes, absolutely
  • It may be an optional extra, but with to-days soaring private medical expenses, it has become imperative to have it
  • It ensures you and your dependents are completely covered
  • Do research on different medical gap cover providers because some offer cover which extends to outpatient treatments
  • In an emergency without funds, you need to know the exorbitant costs of your treatment will exceed medical aid rates


Medical Aids Cap Amounts that Pay for Procedures

It is quite safe to say that more than ever, in 2017, South Africans need gap cover insurance. Without it, you could find yourself seriously out of pocket, not by a couple of hundreds of Rands but by thousands of Rands after you’ve had medical treatment.

Need Medical Gap CoverMedical aid is important if you want the peace of mind of knowing that for illness and injury you’ll be treated in a private hospital. They do, however, cap the amount they pay for procedures.

Most South Africans think that because they have a good medical aid plan, they’re 100% covered, but this is by no means the case. Your medical aid is, unfortunately, going to leave you with medical bills that you never expected.

Have a look at your medical aid policy and take note of the standard payable rates in the small print.  You can ring the billing office of your medical aid and find out about the rates charged by the different medical professionals for common procedures.

You’ll find that there is a shortfall between what a medical specialist charges and what your medical aid will pay. It’s the patient who is left with bills for the amount that forms the difference between the specialist and the medical aid.

Do You Need Medical Gap cover? – a Safeguard

A gap cover policy, bought to enhance your medical aid, is a safeguard in such situations. With medical gap cover, you’ll be able to get the best possible medical cover. Depending on the plan you choose, you’ll be able to claim as much as 500% of the standard medical aid rates.

Medical gap cover has become an integral part of the healthcare industry, and more so since medical practitioners have no regulations when it comes to their charges.

Yes, hospital costs are paid for by your medical scheme. The trouble starts with those private, unregulated fees charged by specialists. What they charge you far exceeds the tariff at which medical schemes pay, and the medical aid isn’t going to pay for this excess amount.

Gap Cover isn’t medical aid. It simply helps the medical aid member to cover the costs of a medical procedure.

You Need Medical Gap Cover like Never Before

The necessity for shortfall insurance in South Africa has never been greater.

Medical schemes also impose copayments for certain medical procedures. This is when members have to cough up an amount upfront or go without treatment. With medical aids increasing these co-payments every year, you need a medical gap cover provider who will cover these co-payments.

There is no getting away from it – you NEED gap cover, because, without it, you could be financially ruined.


To get a FREE gap cover quote, complete the form on this page

All info was correct at time of publishing