Friday 22 January 2016

Do You Need Medical Gap Cover?

What is worse than receiving a bill for medical treatment even though you are a part of a medical aid scheme? A large medical bill is not a “surprise” you want. Fortunately, there is a way to ensure that this does not happen to you.

Gap Cover is ideal for Non-Comprehensive Medical Aid Plans

If you can’t afford a fully comprehensive medical aid scheme, you may want to consider getting gap cover.

South African medical schemes offer various medical aid options with certain prescribed benefits according to how much you are willing to pay. Medical aids will offer 100% (or more) cover for health practitioner and medical bills. Many people come unstuck as they believe that 100% cover means full cover. This is not the case as specialist in the country are allowed to charge the amount they want for their services; therefore they can charge a lot more than the medical aid scheme pays out. Some specialists may even charge a staggering 500% more than the usual rate for their services. So, depending on the percentage of cover your medical aid is willing to pay, you will be expected to pay the difference out of your own pocket.

Gap Cover is a form of medical insurance that you can pay, over and above your medical aid fees, to ensure that the gap fee, which is the extra amount charged over and above for medical aid scheme’s prescribed tariff, is covered.

Benefits of Gap Cover

Different health insurance companies’ gap cover plans and prices may differ. Admed Gap Cover Policy offers the following benefits :

  • Shortfall cover for Medical Practitioner costs
  • Shortfall cover for oncology treatment programmes
  • Shortfall cover for internal prosthesis costs

Additional cover includes:
  • A lump sum of money paid for first-time cancer (stage 2)
  • A lump sum  of money paid for death caused by accident or permanent disability
  • A lump sum of money for long-term hospitalisation
  • Aid for tooth repairs  as a result of damage caused by an accidental injury

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