Understanding Gap Cover Terminology

    Doing research into medical gap cover is important. Therefore you need to have an understanding of what the terms described in your coverage plan exactly means. Indeed, the average person does not know what each term used to describe benefits means.  Hopefully, reading through the terminology listed below will help you when thinking about which medical gap cover plan will work best for you Understanding each one in detail will help you make an informed decision.

    Tariff Shortfalls

    This term describes coverage for the difference between specialist’s fee’s and your medical scheme’s tariff. Shortfall cover is one of the most basic coverages that gap cover plans include.

    Sub-limits

    TerminologyA sub-limit is a limit set within the specific amount of coverage that your medical aid provides for certain in-hospital procedures and treatments. A sub-limit provided by your gap cover plan will ensure coverage for the shortfall that comes when the procedure or treatment exceeds the amount provided by your medical scheme.

    Co-payments

    This is the excess amount payable up front to the medical institution before any treatments and procedures can take place. This benefit provided can help you out in very difficult, unplanned situations.

    Emergency Casualty Benefits

    The casualty benefit option provided covers the facility fee as well as all consultations associated with admissions into the emergency room or casualty ward of private hospitals.

    The casualty benefit option provided covers the facility fee as well as all consultations associated with admissions into the emergency room or casualty ward of private hospitals. Most people don’t have the money associated these costs ready at hand in case of an emergency and having this benefit will cover these instances.

    Hospital Cash Benefits

    This benefit provides a cash benefit for every day spent in

    This benefit provides a cash benefit for every day spent in the hospital. The amount you get will depend on each gap cover provider and some days spent in the hospital. This serves as a great comfort bonus!

    Premature Birth Coverage

    This describes coverage provided when a baby is born 34 weeks into pregnancy or earlier.

    Death/Permanent Disability

    A cash amount is paid out per member who dies or becomes disabled and is no longer able to continue working in his/her specific professional field.

    Medical Scheme Premium Waiver

    With this benefit coverage for medical aid payments of a certain amount per month. This is per family member.

    Dental Reconstruction

    This benefit provides for coverage of dental procedures in the event of trauma, cancers and tumours.

    Deductibles

    These are amounts payable by members upon admission to a hospital.

    Conclusion on gap cover terminology

    The above list is basic terminology used by all gap over providers to describe their benefits. Of course, each provider will offer different value amounts depending on the plan you choose. So understanding what each term means is of great benefit to you. However, you will still need to consult with your gap cover provider to get a clear understanding of what exactly their benefits include and what the value of each will be.  Consulting with various companies or making use of comparing websites will help you source out the best one between them all!

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