The benefits of medical gap cover

2017-07-27 06:01

IF you’re in hospital, you want financial concerns to be the least of your worries.

Medical aids often don’t pay out in full for certain specialists or procedures.

This shortfall is usually manageable for non-urgent treatment because you can plan around the costs of the procedure.

However, a sudden illness or an accident can mean that there’s no time to plan or save, and the shortfall – even on a good medical aid – can run into tens or even hundreds of thousands of rands.

For this reason, increasing numbers of South Africans are turning to medical gap cover – a kind of “top up” medical insurance that covers your medical aid’s in-hospital shortfall.

What is gap cover?

Every year, your medical aid sets a medical aid rate, which is the base rate that can be charged by every medical professional for every procedure.

Most high-end medical aids are then willing to pay up to 300% of this rate. However, many specialists or hospitals charge more than 300% of the medical aid rate. For example, if a surgeon charges 400% of medical aid rates, your medical aid will cover the first 300% and you will have to pay the additional 100%.

Gap cover is a medical insurance product that works in conjunction with your existing medical aid to cover the shortfall between what your medical aid will pay for when you are admitted to hospital, and what the hospital and the specialists charge. So, in the example above, the gap cover would cover the 100% shortfall.

It’s important to understand that gap cover will never cover something that your medical aid excludes (cosmetic surgery, for instance). It only tops up a shortfall on approved procedures, specialists or medications.

It’s always important to read the fine print and make sure that you are comparing the same or similar cover. Look out for what percentage of medical aid rates the gap cover goes up to, as well as for any exclusion.

If you are considering gap cover, you might as well be as extensively covered as possible, so preferably include all the different benefits.

Some gap covers also offer dental benefits for an additional fee, but before you sign on the dotted line, remember that this is likely to only apply for in-hospital dental treatment and not all dental costs.

The bottom line

All in all, gap cover gives you the peace of mind that, should the worst happen, at least you won’t have to worry about coming up with a big sum of money to cover hospital expenses not paid for in full by your medical aid. As the premiums are not overly expensive and the benefits are extensive when they kick in, it’s a good idea to consider putting your family on a gap cover plan.

This article is an excerpt from 1Life.

You could contact me on 083 399 3905, my office on 032-944 3051 or e-mail me on for an appointment or further information and any other financial advice.

Discla imer

The information is only intended to be of a general nature and should not be relied upon by any part without obtaining full details from a licensed financial service provider.

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