Gap Cover can be confusing at times. With so many providers out there as well as explanations as to what exactly Gap Cover or Short-term Gap Cover actually does. So lets take a moment to have a look at some of the in’s and out’s of Gap Cover.
What Exactly Is Gap Cover And How Does It Work? Gap Cover is a form of short-term insurance. Designed to cover the shortfalls in your Medical Aid coverage. Sometimes the fees charges by Healthcare Professionals is higher than the tariff rates that your Medical Aid can cover. Leaving you to pay for the excess fees. These charges are often referred to as Shortfalls.
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Gap Cover is in essence an insurance plan that covers these Shortfalls. However Gap Cover has expanded over the years to include cover for other areas such as Co-Payments as well as cover for some procedures and devices that are not commonly covered by Medical Aid Schemes.
Gap Cover does not replace your current Medical Aid but rather works with your Medical Aid to extend your cover. Gap Cover is a short-term insurance policy and only starts to work after you have claimed from your Medical Aid Scheme. Covering just the shortfall fees.
Do You Need To Be On Specific Medical Aid Scheme To Qualify For Gap Cover?
In short, no. Anyone with a Registered South African Medical Aid Scheme qualifies to take out a Gap Cover Policy with the Insurance Provider of their choice.
Some Medical Aid Schemes do offer Closed Gap Cover Policies for their members only. But these are mostly Closed Medical Aid Schemes.
How Do I Find The Gap Cover That’s Right For Me?
With so many options out there is can be overwhelming. But this also means that there is certainly a perfect Gap Cover policy out there for you.
It is advisable to first think about what gap cover you actually need when looking for a Gap Cover policy. How complete is your Medical Aid cover? What do you most need from your Gap Cover policy? Are you looking for an individual or for a family?
Once you know what it is you need it becomes easier to know if you need a complex, comprehensive plan or something simpler that just covers the important basics.
OPL or Overall Policy Limit – What Is It and How Does It Affect Your Gap Cover Policy?
The OPL is a policy limit that is the annual maximum amount of money your policy provider will payout. The applicable OPL limit applies across all benefits offered policy in question.
If the OPL limit is reached, you won’t be able to claim from your policy for the remainder of that year. However, the OPL renews every year on the 1st of January.
Not a Benefits offered by Gap Cover providers affect the OPL however. Meaning that there are many procedures and claims you can get without worrying about your coverage limit.
Can I Claim My Premiums Back From SARS?
Unfortunately not. Gap Cover is not a Medical Aid all Gap Cover policies are registered as Short-Term insurance policies. Meaning that they are not tax-deductible and no annual tax certificates will be provided by or for your Gap Cover Policies.
- Read here to find out more how much gap cover in South Africa costs