Medical aid is an essential investment for anyone who wants to protect their health and finances. However, it is not always enough to cover all the costs of medical treatments. This is where shortfall insurance comes in. In this article, we will cover everything you need to know about this short-term product for medical aid.
What is shortfall insurance?
Shortfall insurance, also known as medical gap cover, is a type of insurance that covers the difference between what your medical aid pays and what your healthcare provider charges. It is designed to protect you from unexpected medical bills that your medical aid does not fully cover.
How does shortfall insurance work?
When you receive medical treatment, your healthcare provider will charge you for their services. Your medical aid will then pay a certain amount towards these costs, depending on your plan and the specific benefits covered. If the amount charged by the healthcare provider is more than what your medical aid pays, you will be responsible for paying the difference.
Gap cover comes into play when there is a gap between what your medical aid covers and what your healthcare provider charges. For this type of insurance, you pay a monthly premium, and in return, the insurer will cover the difference between what your medical aid pays and what your healthcare provider charges, up to a certain limit.
TO GET A QUOTE, PLEASE COMPLETE AND THEN SUBMIT THE FORM ON THIS PAGE. NOTE: ONLY MEMBERS OF OFFICIAL MEDICAL AIDS IN SOUTH AFRICA QUALIFY.
(HERE IS A LIST OF MEDICAL SCHEMES.)
What are the benefits of shortfall insurance?
Gap cover provides several benefits, including:
- Protection from unexpected medical bills
- Peace of mind knowing that you are covered for medical costs that your medical aid does not fully cover
- Reduced financial burden on you and your family
- Access to better healthcare options without worrying about the costs
How to choose the right gap cover
When choosing a shortfall cover plan, consider the following:
- Your medical needs and the specific treatments you require
- The amount of cover you need based on the difference between what your medical aid covers and what your healthcare provider charges
- The cost of the shortfall insurance premium
- The maximum benefit limit of the policy
- The waiting period before the policy becomes effective
- The exclusions and limitations of the policy
How to claim on your gap insurance
To claim on your shortfall insurance policy, follow these steps:
- Obtain the necessary documentation from your healthcare provider, such as a detailed invoice
- Submit the claim to your shortfall insurance provider, along with the required documentation
- Wait for the insurer to process your claim and pay out the benefits
What are the exclusions of shortfall insurance?
These policies typically have exclusions and limitations, such as:
- Pre-existing medical conditions
- Cosmetic surgery
- Experimental treatments
- Alternative therapies
- Medical treatments received outside of South Africa
- Certain medications
Make sure you understand the exclusions and limitations of your policy before signing up.
How much does gap cover cost?
The cost of shortfall insurance depends on several factors, such as the level of cover you require, the provider you choose, and your age and health status. Premiums can range from a few hundred to a few thousand rand per month. It is important to compare different plans and providers to find one that offers the right balance of cover and affordability.
Who needs gap cover?
Anyone who has a medical aid plan can benefit from this kind of cover. It is particularly useful for those who require expensive medical treatments, have chronic health conditions, or want to access private healthcare facilities. It can also be a good option for families with young children who may require frequent medical attention.
What is the difference between shortfall insurance and gap cover?
Shortfall insurance and gap cover are often used interchangeably, but they are not the same thing. Gap cover is a type of insurance that covers the shortfall between what your medical aid pays and what your healthcare provider charges for in-hospital procedures. Shortfall insurance, on the other hand, covers the difference for both in-hospital and out-of-hospital medical treatments. Make sure exactly what you are buying.
What are the alternatives to gap cover?
If you are unable to afford this type of insurance, there are other alternatives that you can consider. These include:
- Negotiating with your healthcare provider for a lower fee
- Applying for financial assistance or payment plans
- Saving up an emergency fund for unexpected medical costs
How do you buy shortfall insurance?
You can buy shortfall insurance directly from an insurance provider or through a broker. Before choosing a provider, do your research and compare different plans to find one that suits your needs and budget.
How do you cancel shortfall cover?
To cancel your shortfall insurance policy, contact your insurance provider and inform them of your intention to cancel. They will provide you with the necessary forms and instructions for cancelling the policy. Be aware that there may be a waiting period before the policy can be cancelled.
What are the top providers of shortfall insurance in South Africa?
Some of the top providers of shortfall insurance in South Africa include:
- Zestlife (our choice)
- Sanlam
- Old Mutual
- Discovery Health
- Momentum
- Liberty Health
Conclusion
Shortfall insurance is an important form of insurance that can protect you from unexpected medical costs. It covers the difference between what your medical aid pays and what your healthcare provider charges, giving you peace of mind and reducing financial burden. When choosing a shortfall insurance plan, consider your specific medical needs, the cost of the premium, and the exclusions and limitations of the policy. By doing your research and comparing different providers, you can find a plan that suits your needs and budget.
TO GET A QUOTE, PLEASE COMPLETE AND THEN SUBMIT THE FORM ON THIS PAGE. NOTE: ONLY MEMBERS OF OFFICIAL MEDICAL AIDS IN SOUTH AFRICA QUALIFY.
(HERE IS A LIST OF MEDICAL SCHEMES.)
Is shortfall insurance necessary if I already have medical aid?
Shortfall insurance is not necessary, but it can provide additional protection and peace of mind for unexpected medical costs.
What is the waiting period for shortfall insurance?
The waiting period varies depending on the provider and policy, but it is typically between 1 and 3 months.
Can I claim on my shortfall insurance for pre-existing medical conditions?
Shortfall insurance policies typically exclude pre-existing medical conditions, but some providers may offer cover for certain conditions after a waiting period.
How much cover do I need for shortfall insurance?
The amount of cover you need depends on the difference between what your medical aid covers and what your healthcare provider charges. Consider your specific medical needs and the cost of treatments in your area.
Can I buy shortfall insurance if I don’t have medical aid?
No, shortfall insurance is designed to complement your existing medical aid plan and cannot be purchased separately.