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.

Here’s the most common frequently asked questions about GAP cover:

  • What is GAP cover?

It will make up the shortfall for in-hospital expenses. Say you have been admitted to hospital. The medical aid will cover hospital fees, doctor’s fees, anaesthetist’s costs, medicine and supplies. However, medical aid only covers a certain percentage of specialist fees.

Specialists normally charge a lot more than medical aid rates so you could be left with a hefty medical bill. This is where GAP cover comes in. It covers the shortfall, so you are not left with anything to pay.

  • Am I automatically eligible for GAP cover?

You must be a member of a medical aid to be eligible. You can’t take out GAP cover as a separate entity. Once you are a member, there’s nothing stopping you from taking out GAP cover.

  • Does GAP cover kick in immediately?

No, and it’s very important to note this. There is a three-month waiting period before it commences. Also, for pre-existing conditions, there is a 12-month waiting period. So, you can’t take out GAP cover, be admitted to hospital and think it’s going to pay for shortfalls immediately.

It doesn’t work like that. Also, if you have been treated for a chronic illness, such as cancer, you can’t be admitted three months after taking out GAP cover and expect shortfalls to be paid for. After 12 months it will, but not immediately.

  • Are there different packages available for GAP cover?

Yes, there are and different monthly payments that go with the packages. Speak to the companies that offer GAP cover to find out full details.

  • What is covered by GAP cover?

Over and above in paying for shortfalls in hospital specialist charges, there is usually cover for certain procedures that are conducted in the doctor’s rooms. Some GAP cover policies cover more than 50 out-of-hospital procedures. These include arthroscopies, colonoscopies, hernia repairs, PET, CT, MRI scans, cataract removal, vasectomies and dialysis.

Depending on what GAP cover package has been taken out, the policy will cover the shortfall for the cost of hip and knee joint replacement. Make sure that you are taking out the GAP cover that is best suited to your needs. It would pay you to visit the medical aid and have a face-to-face consultation with a GAP company representative, so you are totally clear about everything concerning GAP cover.

  • What isn’t covered by GAP cover?

Any treatment that has not been authorised by your medical aid is not covered. There are exceptions, so find out about them.

Generally, these are not covered – dental treatment unless performed in hospital, crutches and wheelchairs, private or home care, frail care, depression and other mental health disorders and any procedure that falls within the waiting period.