When it comes to IN HOSPITAL costs, many medical practitioners charge up to 5 times the base medical aid rate and for some procedures there are also co-payments. This leads to unexpected expenses, leaving you vulnerable to pay the difference when your medical aid doesn’t cover the full amount. We offer gap cover that pays the difference between your medical aid and actual costs, so you’re not caught off guard. With gap cover, you can prioritise your family’s health and well-being, offering them the best treatment available, without financial stress.
When medical costs exceed your Medical Aid coverage, gap cover steps in to cover and protect you from unexpected costs, so you can focus on your family’s health without financial worry.
How does it work
Gap cover steps in to pay the difference between what your medical aid covers and what your medical bills actually cost. SEE PROVIDERS EXAMPLES – Deon to still include With gap cover, the money is paid directly to you, so you can quickly settle your account with your medical provider, with peace of mind. Our Partners We partner with various premium gap cover product providers to ensure that the most appropriate cover is matched to your needs.
GAP COVER – an essential portion of your health care cover As you probably experienced already, most of the time after you’ve been in hospital or had a medical procedure done, there is usually an amount that the Medical Scheme doesn’t cover and which you have to pay in, that is what we call the shortfall OR GAP! Read further to understand why having Gap Cover is a good decision. Even though the medical scheme covers your in-hospital procedures, you are still exposed to the risk of large out of pocket payments for in-hospital procedures. Specialists charge 300 – 500% more than what your medical scheme pay for in-hospital procedures. These shortfalls can vary from a few thousand rand to tens of thousands of rand. It can be R10 000 or R50 000 or even more. Gap Cover insurance is an affordable way to protect yourself against this once off high risk. It is easier to make provision for a small monthly payment of R250 – R450 per month in your monthly budget than to be confronted with the shock of having to pay R50 000 at once. Listed below are four common medical procedures, with the combined charges of the specialist and anaesthetist. In the third column the shortfalls not covered by the medical scheme are listed. Procedure Amount charged by Practitioner Potential shortfall incured (Payable by Gap Cover*) Colonoscopy R 14 509.82 R 4 805.42 Back Fusion R 81 499.11 R27 949.89 Shoulder Operation R 19 081.86 R11 958.34 Joint Replacement R46 660.48 R23 597.41
