CompliMed gap cover experts help thousands of clients pay medical aid shortfalls via comprehensive, affordable and simple Gap Cover products, helping them when they need it most.
Every South African medical aid scheme member deserves the best healthcare available, and thus CompliMed feels their Gap Cover products are a large part of that belief. Medical aid scheme covers experience shortfalls more than most people realize, and can amount to a hefty sum. In these cases, an individual is responsible for this deficit, which can lead to financial strain and stress. This deficit can be managed by purchasing an inexpensive and thorough Gap Cover product.
Importance of CompliMed Gap Cover
When you, as medical aid scheme member, are told that you are “covered up to 100% of the rate of the medical aid scheme”, you would, like so many, be inclined to think that you are fully covered of all future hospital bills. You would, sadly, be wrong…
Medical aid schemes come up with their own medical services rates, which is often a lot less than the rates being charged by specialists in an in-patient basis. The specialist is not obligated to follow the rates devised by the schemes, and as such, more often than not, they charge more. Much more.
This in turn creates a deficit, or shortfall. Unfortunately, this shortfall is your responsibility as the member. Without shortfall or gap cover, this could leave you several hundred thousand Rand out of pocket.
CompliMed gap cover, since 2003, has been keeping financial ruin at bay on behalf of their clients through their innovative gap cover solutions. They realize that the best healthcare is an essential right that is deserved by every South African.
Medical Aid Scheme Shortfall Examples
The most reported instances where shortfalls are experienced in an in-hospital treatment or procedure scenario are listed below:
- Casualty care – When accidents occur and necessitate a registered hospital’s casualty facility, it may be discovered that your medical aid does not cover casualty care. Generally, medical aid covers you from the point of being admitted, not before. The casualty bay at a hospital is not considered a ward in the hospital, rendering any treatment received there not under medical aid coverage.
- Oncology care – Depending on the medical aid scheme, this benefit is often limited either by capping the amount you can use yearly or levy a treatment percentage co-payment. Gap cover comes in to seal any shortfalls in treatment regimens, whichever form they take.
- Sub-Limit deficits – Some in-patient procedures can cost more than overall yearly benefit limit set by your medical aid scheme, leading to shortfalls that you will have to make up for. Examples of this include permanent pacemakers, hip and knee replacements, etc.
- Procedure co-payments – Co-payments are often applied to certain procedures by some medical aid schemes, making you liable for them. Commonly applied to CT/MRI scans.
- In-Patient Admittance Co-Payment – Hospital admission may attract a co-payment fee with some medical aid schemes.
- Specialist Fee Shortfalls – Particular procedures are charged at a rate higher than your medical aid scheme is willing to pay by the specialist involved.
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