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Five Facts About Gap Cover

With the rising cost of medical expenses in South Africa, it is advisable to take gap cover to account for medical aid payment shortfalls.

Medical insurance cover offers a variety of plans to suit your budget, but the cover does not always align with the rates of medical professional consultations or costs of medication. Some health professionals may charge up to five times the medical scheme rate, while most medical schemes only cover 100% of their prescribed medical scheme rate. This can leave you with significant and unplanned medical bills, when you should focus on recovery. Presodhini Naicker, Head of Brand and Marketing of Old Mutual iWYZE shares five vital things you need to know about Gap insurance.

  1. Gap insurance covers the shortfall between the expenses covered by your medical scheme provider and the actual costs of your hospital or doctors bill. For example, if your medical aid only covers R12 000 of a R16 000 hospital bill, your gap cover would then pay the difference.
  2. Gap cover is not an alternative for medical insurance. Your medical aid will cover most of your medical expenses, but these can be unpredictable and depend on the procedures performed. For example, a planned natural birth could suddenly turn into an emergency C-section due to medical complications and increase costs by double.
  3. Gap insurance pays you directly and not the medical institution or practitioner owed, and reimburses you for the costs you have been billed for by the hospital.
  4. Gap cover is not linked to your medical aid. Changing your medical aid provider does not affect your gap cover. However, you cannot have gap cover unless you have a medical insurance. Medical schemes are regulated by the Medical Schemes Act 1998, while the long- and short-term Insurance Act 1998 regulates health insurance.
  5. You can get gap cover for everyone in the family – you and your dependents – that are covered by a medical aid scheme.

Medical shortfalls could be caused by long treatment intakes, medical conditions that are not or partially covered by your medical insurance, or high specialist costs. Before buying gap insurance, make sure you understand all the facts. Check your current medical aid scheme (most importantly, read the fine print) and make sure the gap cover, literally, fills the gap, giving you peace of mind regarding your health insurance.

Source: Old Mutual iWYZE. Images: Pixabay

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