Why Standalone Gap Coverage is Not Possible
A gap coverage policy is a short-term insurance product.You can’t have standalone gap coverage unless you actually have medical aid.
You can have medical aid without gap cover though. Gap coverage is available from your medical scheme or from an insurance company. It supplements medical aid’s inadequate benefits.
Gap coverage isn’t medical aid – it works hand in hand with the medical aid plan you have. It focuses essentially, but not exclusively, on hospital benefits.
This is also because these days, many medical aid plans are hospital plans. As a top-up policy, standalone gap coverage makes sure that they don’t offer anything your medical aid doesn’t offer.
Without a medical aid plan, there’s no point in knowing about gap cover
Demarcation regulations were introduced to be restrictive to gap cover. To this end a limit has been imposed so that a medical scheme member can only access gap cover up to a certain limit – about R170 000 for each person insured.
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These regulations made gap cover a standalone product – it can never move into the space of medical aid. Without you belonging to a medical scheme, you needn’t get to know about medical gap cover.
Gap coverage – only possible with a medical aid plan
What gap coverage is designed to do is cover the shortfall that exists when your medical aid will only pay for your in-hospital treatments up to a certain point. This can be bad news for you when your specialist sends you a bill way above the amount that your medical aid is willing to pay. This is where gap cover comes in.
Standalone gap coverage isn’t possible on its own. Yes, when you see the lovely, low premiums you’ll be tempted to buy gap cover, but nobody can buy gap cover without first belonging to a registered medical scheme.
Standalone gap coverage isn’t medical aid. It isn’t governed by the Medical Schemes Act, but it works with your medical aid plan, paying for those amounts that your medical aid won’t pay on certain in-hospital treatments.
Having said that, everything isn’t automatically covered by gap cover. It’s important to understand that gap cover doesn’t ever cover something that your medical aid plan doesn’t cover. One of these things is cosmetic surgery, unless it has been approved by your medical aid and specialist as a necessity.
Gap coverage should give you peace of mind knowing that should something happen, you won’t have to worry about massive sums of money to cover those expenses.
Sometimes these bills can be 300% to 500% higher than the rate that the medical aid pays.
Gap cover – essentially augmenting medical aid
Gap cover pays for these shortfall amounts. It augments the cover that you have with your medical aid. Gap cover only pays the shortfall on claims where your medical aid has already partially paid.
If your medical aid doesn’t partially pay an account, then you won’t be able to claim from your gap coverage policy.
For certain procedures and claims that are rejected by medical aid, gap cover can’t help you in these instances.
Gap cover is inextricably linked to your medical scheme. They are two completely different products and yet they have this affinity.
You can have medical aid without gap cover, but then you have to know that you’re entering very deep financial-debt waters.
If you have medical aid, use the form on this page to get a gap coverage quote