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Understanding Medical Aid Gap Cover?
What is Medical Gap Cover?
There is often a gap between what your health practitioner charges for in hospital expenses and the amount your Medical Aid has agreed to pay. That’s when Medical Aid Gap Cover is used. Most medical aids also have defined co-payments that you have to pay on certain in hospital procedures. Depending on the gap cover you choose, these shortfalls could also be covered.
It’s a short-term insurance that makes up the shortfall between your healthcare costs in hospital and your current Medical Aid policy. It protects you from unexpected, exorbitant medical bills.
What’s the difference between Medical Aid and Gap Cover?
It’s important to note that Medical Gap Cover is not Medical Aid or an alternative to a Medical Aid. It is an insurance policy designed to complement your current Medical Aid.
If you don’t have Medical Aid yet, your first step is to compare quotes for a medical scheme that suits you and your family’s needs. Once that is in place, you’ll know what kind of Gap Cover you need.
How does Medical Aid Gap Cover Work?
So why is there a shortfall and how is it settled with Gap Cover? Medical Aid rates and healthcare rates are not the same thing. Medical Aid rates are fixed tariffs and some healthcare providers may charge more than that.
For example, you may have cover for up to 100% of the Medical Aid rate, but be charged 300% for hospitalisation expenses. In this instance, 200% of your expenses would be left unpaid. This is where Medical Aid Gap Cover is vital, as some policies will offer up to 500% above your Medical Aid. Most Gap products also cover defined co-payments imposed by your medical aid for certain in-hospital procedures without Gap cover, which would be your responsibility.
Why is Gap Cover Important?
Gap Cover is an important consideration in South Africa, where private healthcare rates and medical inflation often increase faster than other household expenses, and could become unaffordable.
Don’t put yourself at risk of needing financial assistance should your Medical Aid not cover all your healthcare costs in hospital. Rather protect yourself by comparing Gap Cover quotes in minutes!
Medical Gap Cover Cheat Sheet
When looking at Medical Gap Cover quotes, it’s important to know the terms and have a solid understanding of frequently asked questions. That’s why we’ve put together a glossary and list of FAQs.
Please note: Medical Gap Cover is not a Medical Aid or an alternative to a Medical Aid. It is an insurance policy designed to complement your current Medical Aid.