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640 417 Maysure Financial Services

Gap Cover Benefits: The Shocking Truth About Medical Aid Fees

South Africans are spending more each year on private health cover. Medical insurance has never been more prioritised than now. Yet, it might surprise you to learn that many people still do not have enough money to cover their medical expenses.

Even with the most comprehensive medical cover, you could still pay up to 400% above this tariff. This comes at a hefty cost to unsuspecting consumers. The shocking truth is that even with medical aid quite a few health expenses still need to be paid out of pocket.

As a result, medical gap cover has become a necessity. Carry on reading to find out the benefits of gap cover.

Why Do We Need Medical Gap Cover?

Essential worker wearing PPE

Gap Cover is a short-term insurance product that helps you with financial shortfalls, or “gaps”. These “gaps” can occur when doctors, specialists, and professionals charge more than your medical aid’s rates.

Gap cover helps to cushion the blow. It.carries a person’s medical costs, where that person can’t do it themselves.

While it doesn’t take the place of medical cover, it can cover a significant amount of the shortfall. Gap cover ensures you are not hindered with unexpected medical expenses when you are at your most vulnerable.

Gap Cover for Medical Aid: Benefits

Nurse and patient

Your medical aid may offer coverage of up to 100% of the medical scheme rate, but that doesn’t mean you’re fully protected.

Health care providers and practitioners do not need to comply with regulations when it comes to fees. They can charge over 100%, which can put you in a troublesome position.

Luckily, gap cover comes with several benefits. Let’s take a look at these benefits below.

Medical aid gap cover assists with cancer procedures

This type of cover has once-off benefits that can be used in the situation of:

  • A first-time cancer diagnosis
  • Accidental full disability
  • Accidental permanent disability, or
  • Accidental death.

Gap cover helps with certain casualty fees

Stromtroopers carrying injured stormtrooper in stretcher

Many people who have visited casualty have had the doubly unpleasant experience of having to pay the resulting expenses themselves. Luckily, some gap cover products include a benefit that helps you with any casualty-related expenses.

Offers coverage of certain co-payments

Some medical procedures attract co-payments or fees that are not covered by medical aid. These types of procedures include, among others, radiology scans and claims associated with oncology.

Thankfully, gap cover bridges the shortfall and can cover co-payments.

Secures peace of mind and is inexpensive

Protection against the unforeseen and unknown goes a long way in securing your family’s hopes for the future.

Obtaining gap cover means that in the instance you or a family member are hospitalised, you won’t have any sneaky costs making an already-scary situation worse.

Parent holding her baby's hand

In addition, the premiums for this type of insurance product are not expensive, especially when compared to the extensive benefits they offer you and your loved ones.

That said, you must do the research on the gap cover products available and how they work in alignment with your medical aid scheme.

At Maysure Financial Services, we use Turnberry as our Gap Cover product. More on this below.

Turnberry Gap Cover

We at Maysure use Turnberry as a gap cover short-term insurance provider. We believe it to be one of the top gap cover providers South Africa has to offer.

Their products offer benefits including, but not limited to:

  • Protection against unforeseen medical expense shortfalls
  • Provision of comprehensive cancer benefits
  • Enhancement of medical aid schemes by up to 500% of medical aid rates
  • Affordable prices
  • Coverage for Defined Procedures
  • Extended family cover
  • Emergency assistance by air, land, or sea

Please do not hesitate to get in touch for further information or to make arrangements:

+27 11 839 2302

1024 536 Maysure Financial Services

What is Gap Cover?

In our last post we went over Medical Aid schemes, the different types of cover they provide and how they don’t always keep you covered.

That’s where a product like Gap Cover comes in.

What exactly is Gap Cover? It’s an insurance product that is used to cover the financial “gap” between what your medical scheme will pay for and what is left over, which is what you are expected to pay. It covers the shortfall so that you don’t have to, so to speak. Essentially it’s what’s needed in times of medical crisis and emotional stress, while our minds and emotions are spinning out of control, worrying about how we’re going to foot the huge bill at the end shouldn’t be what we’re most concerned about, it should not even feature in what we’re thinking. Getting better or being there for our families is what matters.

One of the most important things to keep in mind with Gap Cover is that it is used in conjunction with your existing medical aid, this means that in order to qualify for Gap Cover you need to already belong to a medical aid scheme.

While it is made to fill the gap, just like with medical aid and any other form of insurance, there are a few things to look out for.

Gap Cover won’t always fill the entire gap, if your medical aid only pays out 100% of the scheme rate, and your Gap Cover will fill in 200% of that rate, but the specialist is charging 500% of the medical aid rate, you are still liable for 200% of the fee.

So, it is vitally important to work hand in hand with an advisor who understands your needs, your current medical aid scheme and how to pair that with the right Gap Cover plan. And yes, just like medical aid schemes, there are different “packages” and plans which include a variety of extras.

What is covered by gap cover?

  • Medical expense shortfall – this covers the difference between what the medical service providers charge and what medical schemes will pay for treatments performed in hospitals and clinics. Policy dependent.
  • Co-payment cover – this covers your co-payments certain surgical procedures, scans and hospital admissions. Policy dependent.
  • Oncology benefits – oncology or cancer benefits generally offer a once-off lump sum cancer diagnosis benefit. There are also various cancer covers outside of lump-sum benefits. Policy dependent.
  • Internal prosthesis benefits – this would cover the shortfall in the costs of prosthetics. This is policy dependent.
  • Emergency or trauma cover – this would cover the financial gap between what your medical aid provider will pay and what the hospital’s casualty or trauma ward fees are, as long as the injuries are as a result of an accident or serious illness.

You could also be covered for shortfall on dentistry needed due to an accident, permanent disability, trauma counselling and more. Speak to your trusted financial partner to guide you through the options.

In South Africa Gap Cover won’t pay for anything your medical aid hasn’t approved, or any procedures that aren’t being conducted by registered healthcare professionals. Treatments which are excluded by your medical aid are not covered by your Gap Cover plan.

There is so much more we could add to this topic, but we don’t want to overwhelm you. If you have any questions on how you could benefit from Gap Cover, or if you have the right plan feel free to get in touch with us today.

For anything else, feel free to get in touch with us😊

☎️ +27 11 839 2302


1024 684 Maysure Financial Services

Medicember: Everything you need to know about updating your plan

Life happens. It ebbs and flows constantly, this we all know, and try as we may to foresee the future by sound financial planning, thrifty spending during the year and always maintaining our financial responsibilities; the only thing any of us can say for sure about the future is that it is completely uncertain.

When it comes to your medical aid cover the same applies. Although we all try to make sure that we are covered for all eventualities, life has a sneaky way of throwing a curveball when we least expect it. When one of these curveballs comes flying your way it can sometimes be very frustrating to find out that you can only change your cover at a certain time of the year. Sure, if you want to move over to a new medical aid provider entirely, then you can make the change any time, but if you want to upgrade or downgrade your cover using the same provider, you have a limited window period in which to make these changes. The frustration associated with not being able to change cover as your needs dictate can be overwhelming, but there are sound reasons for these rules, even if they aren’t always to your liking.

Most of South Africa’s medical aid schemes will only allow you to make changes during a window period in December. There are many reasons why there is only a short window period for change, but the three main ones are:

  • Changing schemes during the year may result in amounts owing to the scheme you are leaving, due to advanced savings utilised. By only allowing you to make the change at the end of the year, the scheme can be sure that they aren’t in for any financial losses.
  • Unethical misuse of medical funds can occur if a member anticipates that they might need more cover for an expensive treatment in the near future. If members could upgrade and downgrade at any time then it would be quite simple to upgrade your cover if you foresee an expensive procedure in the near future and then simply downgrade again afterwards, once you’ve had the procedure, and so on.
  • Unregulated up and downgrading causes financial instability for the fund. Medical aid schemes rely on pre-calculated payments from you in order to cover all members for the eventualities in their unique cover. Should members be able to downgrade at any time, these financial calculations go straight out the window, and that means that the monthly instalments you pay could fluctuate accordingly. By only allowing a small window period, schemes can ensure that your monthly payment stays constant throughout the year, with increases only occurring on renewal each year.

Medical aids WANT you to stick with them, they want your loyalty. Instead of allowing you the opportunity to upgrade or downgrade at any time of the year many of them offer wellness incentives instead. Schemes offer wellness programmes, which are really worth it if you work with them. They aim at rewarding you for being healthy, offering a definite value proposition that could compensate for the cost of your plan. The tricky part is to get involved and keep up with the programme, but if you do this then you should be able to maintain the plan that you are on until the time comes for up or downgrading.

In extreme cases such as cancer treatments, each case is looked at individually and the scheme you are on would have to evaluate accordingly to see if an early upgrade is warranted.

Also note that should you decide to upgrade or downgrade your plan, there will be no NEW waiting periods imposed on your new plan.

If you are in a position where you are thinking of upgrading or downgrading your medical cover, here are 5 important tips to remember:

  1. You need to be sure about the change.

Study the information on the plans your medical aid offers. Alternatively, contact us to obtain the relevant information.  Most funds have a document available where they compare the benefits and premiums of the plans they offer. Study it, make notes and ask questions!

  1. Understand the plan you’re on and the plan that you’d like to move to.

It sounds obvious, but the first thing you need to do is understand exactly what cover you have on your current health plan. You’d be surprised at how many people don’t read the benefit guides they receive when signing up for a health plan.

  1. Compare costs

Compare the costs of your existing plan with the new plan that you consider moving to. Your current plan’s contribution will increase in January anyway, so it does not help to compare the new plan’s contribution to the current cost. Ask us for help if it gets confusing.

  1. Speak to your provider

Check with us how long your request will take and what their cut-off date is for processing it. You want to make sure that you are well within the window period to avoid further frustration.

  1. Don’t forget to find out about Gap Cover

Most of us think that because we pay monthly fees we are covered in full for all eventualities. Wrong! Finding out afer a catastrophic event such as an accident or unexpected surgical procedure that you are liable for a large portion because of the level of plan that you’re on can be a nasty surprise to say the least. As a rule, if you’re on a higher level plan, the coverage that you get should be higher, but even the very best cover may fall short of high hospital bills. Many specialists are just not willing to accept the medical aid reimbursement rate as full payment, which can lead to large shortfalls which, in turn, become your responsibility. Making sure that you have a great gap cover policy in addition to your medical aid ensures that you are always covered, no matter what the situation. Speak to us to see what would suit you best in this regard.

We understand that deciding on the right medical cover for you and your loved ones, as well as trying to plan for all eventualities can be very daunting and even confusing at times. Reams of documents, rules that are hard to understand and medical aid jargon can often baffle even the most logical minded.  That’s what we are here for. We want to speak to you and take the time to assess what you currently need and what your future needs might be, and should the unforeseen happen, we are also here to assist you with communicating with your scheme to find a positive outcome for all.

Speak to us if your medical needs suddenly change – we can’t promise you the world, but we can promise you a trusted resource who understands that life happens.