Medical Insurance | Gap Cover


Table of Contents:

  1. Medical Insurance | Gap Cover
  2. Medical Scheme Rates Explained
  3. What is Gap Cover?
  4. Cap Cover or Medical Aid?
  5. Conclusion

Often people complain about the extra costs linked with medical aids. We frequently hear our clients say, “Why did my medical aid not pay 100% of the costs incurred?” – This is something we assume will be the responsibility of your medical aid.

Medical aid is a very tricky product to understand. It is ripe with fine print and can be a minefield to navigate. It does not even matter if you are an expert in the field. Most medical aid products are extremely complex and can be somewhat misleading.

Most unwary clients want nothing but peace of mind. The last thing anybody wants is to become bankrupt after an accident. Hospital fees can quickly run into an unruly amount. Medical aid is there to make sure that you have money when you might need it the most.

Medical Scheme Rates Explained

There are many medical aid products available in South Africa. Depending on the cost, you will usually get numerous benefits. Unfortunately, when you sign up for medical aid, you don’t always understand the percentages. Surgeons, for example, will be reimbursed at either 100%, 200% or even 300% of the scheme rate. The sad news is that if you have a medical aid that covers 100% you might have a massive shortfall.
Specialists in South Africa are not regulated as to how much they are allowed to charge patients. Some specialists will charge as much as 500% of your medical scheme rates. It means that the innocent consumer will have to make provisions for the 400% shortfall. This vast difference will often have to come directly from the consumer’s pocket. It means that in South Africa, having just a medical aid that covers you for 100% of costs are most definitely not enough.

Gap-Cover-Family

The reality is that most medical aids operate the same way. You have to make sure you familiarize yourself with the percentages that you are covered for. It can be shocking to discover that you have been paying for years and still have to fork out tons of money when you go to the hospital.

What is Gap Cover?

The term “gap cover” is relatively new in South Africa. Many shoppers are still discovering this service. Gap cover does not form part of your existing medical aid membership. It does not even fall under the same laws. Gap cover is, in fact, a short term insurance product. This means that the Short-Term Insurance Act, not the Medical Schemes Act, governs gap cover.

In the current market, it cannot be stretched how vitally important it is to have gap cover. In modern times, having just a medical aid is simply not sufficient. Even if you are medical, aid contributes as much as 300% of the scheme rate.
Gap Cover Versus Medical Aid

One of the major diffidence’s between traditional medical aid and gap cover is the method of payouts. A traditional medical aid will pay the healthcare provider directly. This method of payment is a regulatory requirement. Gap cover, on the other hand, will pay the consumer directly. It will be the consumer’s responsibility to reimburse all service providers.

Because your gap cover does not link to your existing medical aid, you can chop and change your medical aid. It will not affect your gap cover. With a medical aid, you usually make your claims before your visit. You will have to receive authorization before you enter the hospital, unless it is an emergency. With gap cover, you claim after your medical aid has paid all the relevant service providers. You claim the shortfall. You can claim your co-payments for example.

Gap-Cover-Cost

Cap Cover or Medical Aid?

Everybody must take gap cover over and above medical aid, regardless of the provider or reimburse rate. Gap cover will not replace your medical aid. It is not always in the consumer’s best interest to opt for a lower medical aid. Every consumer will have different needs. It is always best to speak to a trained consultant.

As mentioned earlier, medical aids are a complicated. Some medical schemes will have benefits that are important for out of hospital needs. The unfortunate truth is that you always get what you pay for. Making sure you have a great medical aid is just as important as getting enough gap cover.

Conclusion

At InSHoor™, we represent Essential Med for all our gap cover needs. They are a well-established and trusted provider. They offer affordable rates and great benefits. For more information about Essential med and gap cover, feel free to complete our basic contact form. A friendly consultant will get in touch as soon as possible.

Gap cover is an affordable way to make sure you have enough protection. It does not cost nearly as much as most medical aids. You can cover an entire family for less than R200.

 

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