Don’t for one minute believe that your medical aid scheme will pay all your medical claims. The truth is that more and more people are finding out that their very expensive medical aid plans aren’t covering their medical expenses. Medical aid plans have their rates which are known as medical aid scheme rates. So here we will have a look at Sasfin gap insurance.
Even though your medical aid plan says it will pay 100, 200, 300 or 400% of the scheme rate for medical expenses, specialists charge far more than what medical aids will pay. The amount your medical aid will pay and what the specialist charges you are very different. If your medical aid says they will pay R10 000 for a tonsillectomy but the surgeon charges R20 000, you will have to pay the R10 000 shortfall – that’s if you don’t have gap cover.
Sasfin Gap Insurance
Two Plans From Sasfin
Gap cover from Sasfin is available as two plans –
- Standard Gap insurance– covers the difference between the medical scheme’s tariff and the specialist fees, up to 500% of the medical scheme rate for in-hospital procedures. The cover limits to R1 million each year and for each family. The premium is R130 per family.
- Sasfin Gap Insurance Plus – the premium is R190 per family. Covers the difference between what the specialist charges and what the medical scheme will pay – up to 500% of the medical scheme rate for in-hospital procedures. Cover limits to R1 million for each family each year
– Co-payment Cover – this cover limits to R30 000 per individual or R50 000 per family for every year
– Sub-limitation Cover – cover limits to R30 000 per annum
– Oncology benefit – Cancer treatment in a private hospital is subject to an excess of R200 000 when treatment is in a private hospital. Limited to R100 000 for each person insured and for each year
– Biological Cancer Drug Treatment Cover – limited to R200 000 for each person insured for each year
– Additional benefits on the Plus plan include a Casualty Benefit – limited to R7 500 per family per annum. There is also Dental Trauma benefit which covers reconstruction to the maximum of R33 000. The Premature Birth covers from 42 days for premature birth to the maximum of R11 000. Lastly, there is the Premium Waiver benefit which covers the medical aid premium for six months. In the event of death or disability suffered by the principal member.
Gap Cover – it’s a MUST-HAVE
So gap Cover isn’t a medical aid plan. It’s an insurance product to enhance your medical aid. It to provide you with that additional cover you need when your medical aid plan doesn’t pay for your medical treatments in full.
So gap cover isn’t a nice addition to your medical aid to help you out – it is a critical necessity. Also, without which you could even face the dilemma of selling your home to pay your medical bills.
Complete the form on this page to get a FREE gap cover quote.