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.

Why do you need Gap cover?
A base rate is set by medical aids that medical professionals should charge for procedures and most good medical aids will pay up to 300% of this rate. The problem is that hospitals and specialists often charge more than 300% of the medical aid rate. There’s a shortfall that has to come out of your own pocket.

When you experience serious injuries and conditions that require hospitalization and specialized treatment, the shortfall can be crippling.
Selecting the best medical cover solutions that address the needs of your whole family can help to shelter you from medical expense shortfalls and make sure your family has the care it needs.

What does it cost?
Taking out gap cover means you will pay an affordable monthly amount to make sure your family is covered when you need it most. Premiums usually amount to less than R300 for your family and the premium is exactly the same whether you are a single person or a family.

Providers of gap cover usually allow you to add your spouse and your children to your policy without having to pay any more. Without gap cover, a family may be faced with the choice of getting into financial debt or foregoing treatment their loved ones need.

Costs of starting a family
Medical expenses usually increase considerably when starting a family. When a baby’s immune system is still developing, it can frequently have health problems and costs can easily mount up. The expenses may start with a cesarean section for mom at the birth and spiral from there.

As the baby gets a little bigger, expenses may include a number of in-hospital claims for a tonsillectomy, grommets etc. A tonsillectomy could cost around R19 000 and chances are you’ll be left with a shortfall of about R12 000 if you don’t have gap cover.

Parents of toddlers can expect to have to rush to the emergency room with some injuries as they start to explore. With the right policies in place, you don’t have to worry about your children being able to get the treatment they need.

Changing needs as your family grows
As the nature of your family changes, so your medical needs may change too and you may need to revise your choices.

For instance, as you and your spouse grow older, various medical issues may arise, such as heart disease or cancer and you want to make sure you are covered for all eventualities. For example, some gap covers offer additional benefits for cancer treatment – even for procedures that take place without being admitted to a hospital.

How to claim from Gap cover
In most cases, to claim from gap cover, all you will need is your medical scheme’s statement and your hospital bill. The gap cover is paid out to you and you have the responsibility to make the payments to the various service providers.

Final words
It’s important not to wait until it’s too late to try to find the right gap cover. Be pro-active and discuss your medical needs with your broker if you want to make the right decisions for your family.

It helps to get the guidance of a broker who constantly works with these products. They all come at different prices and offer different benefits. As the premiums for many of them are not too expensive, and the benefits can be fairly extensive when they kick in, taking out gap cover can be of great benefit to your whole family.