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.

Rotator cuff injury

One of the most common Gap cover claims is for a rotator cuff injury. The rotator cuff can become damaged if there has been a trauma to the shoulder but it can also occur with age. The tendons and muscles keeping the shoulder stable and enabling movement are affected.

This injury makes it difficult to do many daily activities, such as getting dressed, brushing teeth and combing hair. When continued pain does not improve with conservative therapy, surgery usually has to be performed. The bills are often way over what medical aids will pay.

Impacted wisdom teeth

Most medical schemes do not comprehensively cover the costs of dentistry. If impacted wisdom teeth are trapped in the gums, they can lead to pain, infection, the development of cysts and misalignment of the other teeth.

If you have to have impacted wisdom teeth removed, you may need to be admitted to hospital and have general anesthesia. Comprehensive Gap cover can help to ease shortfalls if this is necessary.

All new policies are subjected to waiting periods so if you know you will need your impacted wisdom teeth removed at some stage, it’s better to take out Gap cover sooner rather than later to make sure you’re covered.

Osteoarthritis of the knee

Gonarthrosis (osteoarthritis of the knee) is one of the most commonly claimed for ailments when it comes to gap cover. It occurs due to progressive deterioration of the cartilage that covers the ends of the bones forming the knee joint.

Physical activity, obesity, and trauma contribute to the problem. Once the damage has occurred, it does not go away as cartilage is unable to repair itself.

This is a very common condition and it may be necessary to do surgery. If you don’t want to find yourself caught off-guard with a hefty medical bill, comprehensive Gap cover can make a difference if you have to undergo knee surgery.

Breast cancer

Breast cancer affects the lives of millions of South African women and their families. The dreaded diagnosis can be emotionally and financially devastating.

Some of the expenses involved in treatment include radiotherapy, chemotherapy, surgeries, skin grafts, mastectomies, reconstructions, and medications. Once-off as well as monthly treatment costs often result in shortfalls.

Once your medical scheme benefits are depleted, you could be looking at paying a considerable amount on a monthly basis to healthcare providers. Many plans offer a lump sum when cancer is diagnosed for the first time. The amount of this lump sum can vary considerably. Providers may also contribute to payment costs once your medical scheme benefits have run out.

Some providers offer cover for biologics – protein-based therapies derived from living cells that cost a great deal but have revolutionized the treatment of some cancer.

Cesarean sections

For some women, it is necessary to have a cesarean section and others choose to undergo one. As more women are having them than before, and they need to stay in the hospital for longer, this puts pressure on medical schemes.

Fewer gynecologists are going into practising obstetrics due to the high input costs in the profession (such as malpractice insurance). This pushes up prices all round and gap cover can help to cover shortfalls when families welcome a new addition to the family.

The bottom line

These five common conditions could leave you considerably out of pocket due to the high costs of surgery and recovery. Gap cover can give you peace of mind and ensure you have the treatment you need without worry. It’s important to speak to your broker to make sure you select the best gap cover for your specific needs.