Why Buy Medical Gap Cover?

December 18, 2021

People are asking plenty of questions about their medical aids in the 21st century. And they are asking: Why buy medical gap cover? too.

They are tired of paying, paying, paying for less. One of the biggest mysteries surrounding medical aids for most people is understanding how they work. People think they have full cover because their medical aid says it pays at 100% of the scheme rate. They are amazed to find they have to pay in hard cash as well as their medical scheme premiums.

Why Buy Medical Gap Cover – Specialists Remain Unregulated

You need medical gap cover because specialists in South Africa aren’t regulated. That means that they charge their patients more than the 100% rate which medical aids will pay. That can sometimes be as much as 500% of the scheme rate. And that means you have to pay the shortfall amount.

For example, a caesarian section is a very common medical procedure in South Africa. The total cost of this procedure could be a process which costs about R12 600. The scheme rate (100%) means that the medical aid will only pay roughly in the region of R4 200. That leaves you with a bill to cover of R8 300.Why Buy Medical Gap Cover

You need to buy medical gap cover because it doesn’t form part of your medical scheme membership. There is no regulation of gap cover by the same laws as medical schemes.  Your medical aid will reimburse your specialist or hospital when you are hospitalised, but your gap cover provider will refund you, and it is your responsibility to reimburse the service provider.

Why Buy Medical Gap Cover? – Talk to a Professional Broker

In South Africa, it doesn’t matter which rate your particular medical scheme reimburses at, you need gap cover, and sooner rather than later. People often ignore gap cover and find out too late that they have to sell off some of their goods just to pay massive medical bills they believed their medical aid would pay. Gap cover is necessary because it helps employees manage all those exorbitant out of pocket costs with an illness or in a health crisis.

The need to incorporate gap cover to your medical aid is vital. Specialist fees have increased dramatically in recent years – quicker than what the medical aids can contend with.

Supplementary products such as gap cover take care of those out-of-pocket medical costs. While medical aid members don’t like the idea of having to fork out for yet another insurance product over and above their medical aid premium, these medical gap cover policies have become an invaluable addition to a medical aid.

It is in the interests of every medical aid member to understand how gap cover works and to ask for guidance from a professional broker as to how it can be of assistance to you. It certainly isn’t replacing your medical scheme, but rather complementing or supplementing it.

Many people opt to downgrade their medical aid plans, but this is why it is so important to talk to an expert. A gap cover policy might not cover a reduction in medical aid benefits.

Why Buy Medical Gap Cover – Avoid Financial Predicaments

Primarily, gap insurance covers the shortfall that comes about because a specialist charges up to 600% more than what your medical aid will pay. Medical aid members can be left in a severe financial predicament. Medical scheme cover is full of complexities and deciphering how it all works can be frustrating and futile without the help of a professional broker.

Why Buy Medical Gap Cover – Gap Cover is Critically Important

Face reality: there are precious few medical schemes that provide full comprehensive cover for in-patient specialist care. Without gap cover, the member faces significant shortfalls for the member to pay. You need gap cover. It is an affordable benefit to supplement medical scheme cover. Medical experts tell us that shortfalls in the region of  R20-50k are commonplace. So gap cover is something you have to have if you want to avoid going into debt review.

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All info was correct at time of publishing