The Complete List of Gap Cover Providers in South Africa

Gap cover is becoming increasingly necessary among South Africans who belong to a medical aid. Soaring medical costs mean that medical aids do not always cover the full costs of consultations.

Consequently, many South Africans are turning to gap cover products. Most medical aids set an MST (medical scheme tariff) which is the amount they are prepared for the services of private healthcare professionals. However, the actual rates may differ.

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Protect Your Family with Gap Cover

The cost of private health care in South Africa has increased considerably over the past decade. The gap between what you’re charged by private specialists and hospitals and what your medical scheme pays out is potentially very high.

It can be a problem to afford proper medical care for your whole family. Taking out gap cover is one way to improve your cover.

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Gap Cover for Emergencies and Accidents

Most of us probably think gap cover is important for those with serious illnesses or health risks. We tend to ignore the fact that we are all faced with accidents and emergencies at times.

A sudden emergency or accident means there’s no time to plan or save. The shortfall, even when we have a good medical scheme, can put us at a great financial disadvantage for a long time. This is when having Gap cover can really make a difference.

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Top 5 Common Gap Cover Claims

The most common Gap cover claims are for conditions that affect many South Africans. Those who do not have gap cover can suffer serious financial consequences when undergoing treatment for these common issues which often come at a high cost.

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What Gap Cover Does Not Cover

Many people who have a basic medical scheme and take out Gap cover believe they are completely covered, but this is not always the case.

Gap cover is designed to cover the shortfall between what your medical scheme pays and what is charged by private doctors or hospitals. For example, if a specialist visits you in hospital and charges you R1 000 and R600 is covered by your medical scheme, your gap cover would pay R400 – or so you hope.

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Three Reasons Why You Need to Take Out GAP Cover

There are probably 50 reasons why you should take out GAP cover, but here are three of the most important ones:

  • GAP cover will take care of the shortfall of specialists’ fees with an in-hospital procedure. Specialists always charge more than medical aid rates so there is always a shortfall. If you haven’t got GAP cover, you are liable for the payment of the shortfall – and it could be a very hefty sum.
  • Some hospitals and comprehensive medical plans offer cover at 100%, 150% or 200% of medical aid rates for hospitalisation costs only. The actual costs, much to your surprise, could well be more than 500% of medical aid rates. GAP cover will make up the difference between what is paid by your medical aid and the actual cost.
  • There are certain procedures that are now performed in doctor’s rooms, or day clinics, and these will be covered by GAP cover. However, the procedures and their authorization vary between companies. It is always best to check what procedures can be performed.
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The Most Common GAP Cover Frequently Asked Questions

GAP cover was recently introduced into the healthcare scenario in South Africa. It’s a welcome advance in financial protection for the patient, but unfortunately, its marketing has been sadly lacking so not many people know what it’s all about. Many don’t know it even exists.

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What Is Covered Under A GAP Cover Policy?

A GAP cover policy is designed for members who belong to a medical aid society already. It covers shortfalls in hospital cover where surgeons, anesthetists, scanning specialists and other in-hospital procedure personnel charge more than medical aid rates.

In most instances, and depending on the medical aid you are with, you are left with bills that you never thought you’d have to cover. Medical aid will only cover a certain amount, and there is an amount over which you must come up with.

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What Is GAP Cover And How Do I Qualify?

GAP cover is an added medical aid product that can be used in the event of additional costs for a hospital procedure or emergency surgery.

There are four vital points to remember with GAP cover.

  • It can only be taken out if you belong to a medical aid already.
  • It can only be used for in-hospital procedures.
  • There is a three-month waiting period before GAP cover kicks in.
  • If your add-to medical aid package, for instance, an additional package to your medical aid for cancer, has been exhausted, you must wait 12 months for your GAP cover funds to be used specifically for that condition.

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