There are certain facts about medical gap coverage. They say that medical schemes are not-for-profit, but that is exactly what they are – profit-making. They rake in massive premiums from their members and cover less and less. This is key to understanding medical gap coverage.
Medical schemes cleverly make out as if they work towards the good of all their member, and while this is partly true, they make sure that they’re financially flourishing. Medical scheme inadequacy for members led to the innovation of medical gap coverage.
Medical aids restrict the cover they offer, and members of a medical scheme have to then invest in medical gap coverage to pay for the many times medical aid only partially pays for a medical procedure.
The fact is, if you belong to a medical scheme, you need medical gap coverage.
Co-payments are another obstacle to treatment
Medical aid members even have to pay co-payments upfront if they want a certain treatment. Don’t pay and don’t have treatment – it’s as simple as that. On top of that, they tell their members to only use certain hospitals and certain doctors.
They put caps on what they will pay for certain services. They make you sick and without gap cover, you don’t stand a chance against them.
As you can see, medical aid has these massive gaps, and without medical gap coverage you are going to always be out of pocket.There are many gap cover providers with premiums starting in the region of R200 a month for a single member under the age of 65.
You’re all covered under just one policy
The value of this gap cover lies in the fact that most providers cover the principal member and all family members under one policy. People on different medical schemes can be on one gap policy too.
Medical schemes can’t discriminate according to age, but with gap cover, these short-term insurers have two prices for their policies – a price for under-65s and one for over 65s. However, with research, there are one or two gap cover providers who have no age differentiation.
The gap cover providers offer some core benefits –
• co-payments
• shortfalls – when your medical scheme pays only a proportion of the costs of treatment
• sub-limits for when cover is limited to a certain amount
• accident emergency casualty
You will hear about medical schemes paying 100% to 300% of the cost, which is essentially 100 or 200% of the scheme’s rate.
It can leave you paying a lot of money that you may not have. Everyone wants gap cover to cover 500%, and you can – but the fact is, you need one of the top plans.
Know which medical gap coverage benefits are essential
You have to do good research for these gap plans as the facts are there – some benefits offered are marvellous to have but not essential.
Gap covers have waiting periods too. All gap covers have these waiting periods for all those joining gap cover.
Make sure your gap cover matches the medical expense shortfalls you will need.
Gap cover is still cost-efficient and there are a good number to choose from. You can’t get gap cover without medical aid and another important aspect is to realize that gap cover won’t cover anything your medical aid plan excludes.
Gap cover is all about giving you that peace of mind knowing that when medical aid doesn’t pay in full for certain procedures, gap cover will step in and pay it for you.
Complete all the fields in the form on this page, then hit the Get a Quote button so we can send you a medical gap coverage quote.