ADVERTORIALThe importance of medical gap cover

2016-04-07 06:00

Juggie Govender of East Coast Financial Services (Pty) Ltd – FSP: 44760


Most medical schemes only cover the costs of in-hospital specialist treatments, at the Medical Aid Tariff (100% or 200%).


Most specialists charge substantially more than the Medical Aid Tariff, for example, anywhere between 200% and 350% and thus leaving the member liable for the shortfall.

Other costs that a member can be liable for:

·co-payments on selected procedures or services for example MRI/CT scans;

·hospital admission co-payments; and

·co-payments as a result of sub limits being exceeded

·co-payments for the usage of a non-network hospital


What is GAP Cover you ask? Medical GAP Cover covers the shortfall between what the medical aid pays (tariff) and what the specialists charge, up to 500%.

Some GAP Covers may also cover the specialist shortfalls arising from a defined list of out patient procedures.

Hospital admission co-payments, MRI/CT co-payments and claims for the usage of a non-network hospital may also be covered by GAP Cover, depending on the benefit option the client has selected.


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