Health - FAQ's For Medical Gap Cover

What is gap cover?
Everyone goes to hospital sometime in their life, sometimes for simple things, sometimes not. Costs (excluding the hospital bill) for certain procedures can run into thousands of rand's, which, if you are not fully covered, might cause financial ruin.

With Medical Gap Cover, you will not need to worry about paying the extra cost for a hospital procedure you may have to undergo. There is a good possibility that you have to pay the specialist from your own pocket for a hospital procedure.  Medical gap cover covers costs such as these.
Why Gap Cover?
In most cases, members have a shortfall between what the medical scheme pays and the actual cost, because the Service Providers are entitled to charge more than the tariff rate.

The shortfall then becomes the member's responsibility and he/she will therefore need to have additional cover in these circumstances.
Some Hospital and Comprehensive Medical Plans offer cover at 100%, 150% or 200% of the medical practitioner tariff rates, while the actual costs could be more than 400% of tariff rates. Gap Cover will cover the difference between what your medical scheme is willing to pay and the actual cost of in-hospital doctor's bills up to a maximum of 500% of tariff.
Who can apply for Gap Cover?
Gap Cover is available to individuals currently on a medical scheme.
Does it matter how large my family is?
No. However, certain products do limit the size of the family, or require certain criteria e.g. that all insured members must belong to a Medical Aid in order to qualify for gap cover.
What is the cancellation period?
Cancellation varies from a 30 day to 60 day cancellation period before any debits are stopped on your account.
Waiting Period
The waiting periods clauses varies depending on the insurer.

Pre-existing conditions are excluded for 12 months after the commencement date of the policy.
Benefit limits
The annual limits varies depending on the insurer.

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