You Need Gap Cover for Medical Schemes

December 17, 2021

Gap cover for Medical schemes helps to avoid huge medical bills you never expected. Your medical aid plan agrees to pay 100% of your treatment bill. However, this does not relate to the actual fee charged by members of the medical profession.

Known as the National Health Reference Price List (NHRPL). The Health Act sets the rates as a guideline to specialists. The profession do not follow these guidelines and instead set their own rates.

Gap Cover for Medical Schemes

Here’s an example of how the 100% payment rate falls short: Let’s say the cost of a CT Scan in a hospital is R2,575.90 by the NHRPL guideline. But your specialist charges you R7,727.70.

Working to your medical aid rate (defined by NHRPL), this amounts to 300% more than what your plan pays. And you have to pay the shortfall of R5 151.80.

Gap Cover – What is it?

Gap Cover is all about insuring you for the gap in what your scheme pays for hospital treatment, and what the specialists charge you for their services.

Without Gap Cover, you leave yourself open to a cash crises. And, we all know that the cost of health care today is not cheap!

The medical professionals can charge what they like when it comes to tariffs. Their fees have played a part in the increase of health care fees.

You can afford Gap Cover on the other hand. It has easy monthly fees to give you and your family peace of mind.

Who Qualifies for Gap cover for Medical Schemes?

Anyone who is a member of a South African medical aid scheme may apply. You can Gap cover any family members on your plan too.

However, there is nothing to stop you from downgrading your health care benefits to add to your Gap cover monthly fees. Just ensure you cover all your health needs.

Get a Quote for Gap Cover for Medical Schemes

If you are keen on Gap cover, complete the form on this page and get a gap insurance quote. Your details will not be shared, but for a fair and proper quote the insurer needs to know all about you.

All info was correct at time of publishing