Discovery Health is one of the most well-known medical aid providers in South Africa. However, even with a comprehensive medical aid plan, there are certain expenses that may not be covered. This is where Discovery’s medical aid gap cover comes in. In this article, we will take a closer look at Discovery medical aid gap cover and what it offers.
What is gap cover?
Gap cover is a type of insurance that covers the difference between what medical professionals charge for their services and what your medical aid plan will pay for those services. It is designed to cover the “gap” between these two amounts, which can often be substantial.
Gap cover is particularly useful for those who have medical aid plans with lower benefits and are concerned about the costs associated with medical procedures. It can also be useful for those who require regular medical procedures, such as dialysis or chemotherapy, as these can quickly add up.
What is Discovery Medical Aid gap cover?
Discovery’s medical aid gap cover is designed to cover the difference between what your medical aid plan pays for and the actual cost of medical procedures. It is available to anyone who has a Discovery medical aid plan.
There are two different options available for Discovery medical aid gap cover. The first is the Comprehensive Gap Cover, which covers in-hospital and outpatient procedures, as well as co-payments and deductibles. The second is the Primary Care Plan, which covers in-hospital procedures only.
Comprehensive gap cover
The Comprehensive Gap Cover option from Discovery is designed to cover the difference between what your medical aid plan will pay for and the actual cost of medical procedures, including in-hospital and outpatient procedures, co-payments, and deductibles. This is particularly useful for those who have a medical aid plan with lower benefits or who require regular medical procedures.
Some of the benefits of the Comprehensive Gap Cover include:
- Cover for all in-hospital and outpatient procedures, as well as co-payments and deductibles.
- Cover for medical professionals who charge more than your medical aid plan’s rate.
- No overall limit on cover, so you can claim for as many procedures as you need.
- Access to a personal claims consultant to assist you with your claims.
- Access to the MediTaxi service, which provides transportation to and from medical appointments.
Primary Care Plan
The Primary Care Plan is designed to cover the difference between what your medical aid plan pays for and the actual cost of in-hospital procedures only. This option is ideal for those who have a medical aid plan with higher benefits and only require cover for in-hospital procedures.
Some of the benefits of the Primary Care Plan include:
- Cover for in-hospital procedures only.
- No overall limit on cover, so you can claim for as many procedures as you need.
- Access to a personal claims consultant to assist you with your claims.
- Access to the MediTaxi service, which provides transportation to and from medical appointments.
How does Discovery medical aid gap cover work?
Discovery medical aid gap cover works by covering the difference between what your medical aid plan pays for and the actual cost of medical procedures. This means that if you have a medical procedure that costs more than what your medical aid plan will pay for, Discovery will cover the difference.
When you sign up for Discovery medical aid gap cover, you will need to provide information about your medical aid plan, including the type of plan you have and the benefits it provides. Discovery will then determine the level of cover you need based on your medical aid plan and the procedures you are likely to require.
When you have a medical procedure, you will need to submit a claim to your medical aid plan as you normally would. Your medical aid plan will then pay their portion of the bill. Once this has been done, you can submit a claim to Discovery for the difference. Discovery will then pay the remaining amount,