Why is Gap Cover for Medical Aid Necessary?

December 9, 2021

With the ever-increasing costs of private medical care, you have to ask yourself a simple question: Is gap cover becoming a vital part of medical care in South Africa? And also: Why is gap cover necessary?

The answer is yes. Increasing costs within a sector that government regulates makes it almost impossible for medical aids to cover all the hospital bills. Yet the cost of medical aid continues to increase without comparative increases in benefits.

Medical aids do not pay all your medical accounts. This is the case for accounts for in-hospital treatments, as well as day-to-day claims and out-of-hospital treatments. Regardless, medical aid is still expensive even if the cover is not always sufficient.

Many medical aids are only willing to pay a certain amount of the medical account for specific procedures. The remaining amount becomes the responsibility of the main member of the medical aid.

Certain procedures also require the medical aid member to make a co-payment when admitted to the hospital. This can be a substantial amount especially if the hospital admission is unplanned.

Why is Gap Cover Necessary

Why Is Gap Cover NecessaryMedical shortfall insurance plays an important part in today’s healthcare. It provides you with the peace of mind that someone will pay your hospital accounts even if your medical aid does not cover all the costs.

Medical practitioners do not have a set rate at which they charge patients for treatment. Your medical aid will set a medical aid rate on which medical practitioners can base their rates. However, medical practitioners often charge more than 300% of the medical aid rate. This is also the case with treatment in-hospital.

Gap insurance is vital because it will pay the shortfall created when your medical aid does not take care of the entire bill. In its most basic form, top up insurance can be seen as insurance to pay your bills when you or a dependent are admitted to hospital.

Insurance is always a good idea. A small monthly contribution towards gap cover insures that your family is protected from high hospital bills.


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Hospital and co-payment cover

It is important to understand that gap cover is for in-hospital treatment bills. Out-of-hospital treatments do not necessarily have coverage.

Your gap insurance product may include extra benefits for certain outpatient procedures, cancer treatments, and additional features. This will be dependent on the specific gap product.

It is clear that these additional benefits make gap cover a very appealing product.

You can avoid high hospital accounts and co-payments by getting gap product from a registered provider. Doing this can save you lots of money when it comes to the hospital and related accounts.

It makes sense to get gap cover when you know you have big hospital procedures in the future. Take note that gap cover may have exclusions for up to 12 months and that pre-existing conditions may not have coverage initially.

Gap cover is beneficial for all members of a medical aid and well worth the small expense.

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All info was correct at time of publishing