Gap Cover: The Short-Term Insurance That You Absolutely Need Over and Above Your Medical Aid

Posted at 09:00:00 on the 2017-10-09

Gap Cover – do you really need it? Not really, unless, your health is everything to you. As Josh Billings, famous 19th century humourist, once mused: “Health is like money.

Is Gap Cover Worth it and Do You Really Need It?

We never have a true idea of its value until we lose it”. And Gap Cover helps to ensure that you have sufficient cover to get the healthcare you deserve.

Gap Cover Options

Gap Cover provides benefits for members and their dependants who are covered by a registered medical aid scheme. Generally, you can only be on two different medical aid policies and one Gap Cover Policy if you are a legally married or common law (proven to have lived together for a certain period of time) couple. Gap Cover is not a substitute for medical aid scheme membership.

The cover includes procedures such as:

  • All emergency procedures,
  • Sterilisations,
  • Vasectomies,
  • Tonsillectomies,
  • Appendectomies,
  • Gall bladder removal,
  • Procedures and conditions not specifically excluded where a medical aid has failed to meet its full obligation in this regard, and
  • Prescribed Minimum Benefits (PMBs) where a medical aid has failed to meet its full obligations.

There is no entry age limit. There is, however, an aggregate Gap Cover annual limit of R150 000 per insured person per annum (This is subject to annual review-amendment).

As everyone’s health needs and budget differs, there are assorted options available. Most Gap Covers offer entry level, comprehensive and high-end options.

How Does Gap Cover Work?

Medical professionals are charging ever-higher rates for their services. To remain viable, medical schemes have in turn implemented more and more restrictive conditions of payment. Despite being covered by medical aids, many members have experienced increasing out-of-pocket payments to cover the shortfall between the inflated medical expenses and what medical aids are willing to pay.

Even top-of-the-range medical scheme options can be subject to a difference between what they pay and the amounts specialists charge. For this reason, Gap Cover is a market that continues to grow – especially since the new regulations have cleared up uncertainty.

Total Risk Administrators

For more information, please contact your intermediary today.

Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.

The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.