Medical Aid Gap Cover

Why do you need medical aid gap cover

Why do you Need Medical Aid Gap Cover

Doctors are not regulated and as such will often charge above your medical aid rate of cover.

Your medical aid will only provide cover according to the scheme rate, apart from that, procedure, and admission co-payments, as well as sub-limits, are becoming more and more prevalent within medical aids today.

Gap cover is not a luxury but a necessity if you are on a registered South African medical aid and will safeguard you from such shortfalls and co-payments.

It is only when you experience shortfalls, co-payments, and sub-limits that you realize that medical aid Gap cover is a much-needed safeguard, so it is advisable to take the pro-active approach rather than the reactive approach and apply for medical aid Gap cover as waiting periods will apply from your first day of cover.

How does Gap Cover work?

medical aid Gap cover works by covering the difference or shortfall between what your doctor charges and what your medical aid pays from the Risk or hospital benefit. Depending on the option you select, you will also have cover for medical aid Co-payments, Sub-limits, and cancer treatment shortfalls.

How does gap cover and medical aid differ from one another?

Medical aid Gap cover is not a replacement for a medical aid. Gap cover serves to cover shortfalls where doctors charge above medical aid rate, and where medical aid pays up to their specified rate from the Risk or hospital benefit.

Over and above this, Gap cover will also provide cover for the following areas of shortfall depending on the option you select:

Medical aid Co-payments
These are upfront
Sub-limits
Oncology shortfalls

medical aid Gap cover cannot provide cover where medical aid does not pay towards a procedure or covers the full amount for a procedure.

Medical aid serves as the primary point of health cover and will cover your stay in hospital as well as approved Medical procedures at a specific rate of cover according to the medical aid option you select. Gap cover serves to guard you in the event Doctors charge above your medical aid rate of cover and a shortfall is incurred after medical aid pays from the risk or hospital benefit.