About Western Gap Cover
Western gap cover was created to give clients the reassurance that the best medical care will not be denied to them due to shortfalls in medical aid scheme limits.
Why You Need Gap Cover Insurance
Western gap cover is a crucial compliment to health insurance in that it protects you against out of pocket payments for specialists and their treatments, which your medical aid may not cover.
This also includes price hikes that are over and above the average inflation rate. These shortfalls can and do exclude many from important medical care that they otherwise require and deserve.
Quality healthcare is increasing in cost, and these increases far outpace median inflation rates, at times to the tune of over 500% of the rates medical aid schemes are willing to pay! These shortfalls are left to fall on patients, which can result in financial strain if gap cover is not employed.
Common Shortfalls Attributable to Medical Aid
Shortfall can be experienced in a number of scenarios when seeking in-patient treatment or procedures at a hospital. Some common ones include:
- Tariff shortfalls between medical aid rates and actual cost of procedures
- Co-payment for Hospital Admission – Admission into in-patient care requires a co-payment with some medical aids
- Co-payments for certain procedures/treatments – Liability for the cost overruns on certain stipulated in-hospital actions will fall on you if you do not have gap cover
- Sub-Limit Shortfalls – Some medical aids place limits on annual basis on some benefits, meaning if you require that particular benefit and the cost overruns the stipulated limit, a shortfall will arise
- Oncology Management – depending on the medical aid scheme, limits for cancer treatment can be placed either on an annual tariff basis or requiring a co-payment that kicks in following the exhaustion of the yearly cover limit
- Casualty Care – Some medical aids do not recognize the casualty unit of a hospital as a ward, therefore cover may not include treatment given there.
Western Gap Cover Benefit Details
- A contribution waiver, should the main member of the medical aid scheme either be permanently disabled or pass away;
- Accidental disability and death benefits – for either the main policyholder or their dependents;
- In-patient cost gaps;
- Pioneering medications – innovative medicines approval;
- Maternity booster;
- Unplanned fatality – emergency treatment and/or operation/s following an accident;
- Dental reconstruction – in-patient reconstruction surgery in the event of cancer, trauma or an accident;
- Step down capacity – applies to Sub-Acute or Step Down Recovery facility in-patient admissions;
- Oncology initial diagnosis and co-payments – radiotherapy or chemotherapy, specialized or basic radiology, biological cancer treatment or drugs, specialist consultations and pathology shortfall payments;
- Consumables, whereby internal appliances, materials and medicine shortfalls during a procedure carried out in a hospital are reimbursed;
- Deductibles, penalties and co-payments;
- Medical aid scheme shortfalls or gaps, amounting to 500% of the medical aid scheme costs. This benefit relates to the service charges on either an out-patient or in-patient basis that are levied by a specific health doctor.
Western gap cover allows the choice of whichever specialist or doctor will administer the best quality healthcare, regardless of the cost and regardless of the limits imposed by your medical aid. The best care is covered by Western Gap, giving you peace of mind and not having to stress about further medical bills.
Complete and submit the form on this page to get a quote