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.

Costs of emergencies and accidents

Costs at the time of an accident or emergency can come in the form of casualty bills, scans, other tests, medications, and consultations with in-hospital specialists. Most of us are unprepared for such expenses and they can mount up quickly. This is when Gap cover can help to bring some peace of mind and a chance to recover fully without worry.

Gap cover for you and your dependents

Gaps can arise in different areas. One of these is the difference between what medical service providers charge and what medical schemes cover. Another area is when co-payments are charged or sub-limits are imposed by schemes for high-cost services.

Gap cover insurance policies provide benefits for medical scheme members and their dependents where these gaps occur. One of these areas is when individuals are treated in casualty or emergency wards.

Some of the products even cover things such as physiotherapy required to help a patient recover whilst in-hospital or trauma counseling. In the case of permanent total disability or accidental death, a lump sum may be paid out.

What could happen in an emergency

Consider the following scenario. Your son falls off a swing and you take him to hospital. He is seen by an orthopedic surgeon who decides he needs an operation on his arm. The surgeon and the anesthetist charge private rates which exceed the rates payable by your medical aid.

There is a considerable shortfall. Your medical aid will not cover the bill in full because they say that the injury did not meet the Prescribed Minimum Benefit definition of an emergency.

Despite the fact that medical emergencies must be covered legally in terms of the prescribed minimum benefits (PMB), what constitutes an emergency is open to interpretation.

The Medical Schemes Act states that medical emergencies aren’t to be paid from medical savings accounts. Unless your emergency clearly falls under PMB, you will probably have to use your day-to-day benefits to cover costs and these can run out very quickly.

When is the failure to give treatment against the law?

In terms of the regulations, an emergency is an unexpected onset of a condition that requires treatment, where failure to provide that treatment would put a life in jeopardy or result in serious impairment of a body part or organ.

Gap cover providers are offering benefits to help cover accidents and emergencies because Many people experience problems regarding payment when they least need it – in an emergency room when they already under stress.

In the case of emergencies or accidents, you don’t want to have to worry about whether you will have cover or not. You don’t want to be forced to make an upfront payment that you can’t claim back and you certainly don’t want to be turned away altogether because you can’t afford to pay upfront.

Taking out gap cover may be preferable to moving up to a higher medical scheme option unless you are over 6 and your premiums are more expensive.

The bottom line

Gap cover can give you peace of mind should you or your family be involved in an accident or have some kind of emergency. You won’t have to try and come up with a big amount to cover hospital expenses that are not covered. You will be able to take the time needed to recover fully without financial stress to add to your worry.