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Medical aid

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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

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

+27 11 839 2302

info@maysure.za.com

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

📧 info@maysure.za.com

1024 536 Maysure Financial Services

Everything You Need To Know About Medical Aid

Having medical aid is an absolute essential in South Africa, especially when you consider how overburdened the state institutions are.

We had a look at all the information available online and realised that while there are hundreds of articles available on medical aid, many of them are hard to digest for people who aren’t in the industry, and we wanted to simplify a few things for our clients.

Firstly, medical aid is essentially health insurance used for financial protection against the risk of incurring medical expenses during your and your family’s lifetime. What this means is that if you are injured, sick or hurt, your medical aid can be used to pay part, most or all of the expenses when this happens. This will depend on the type of cover you have, the incident and healthcare professional or institution (hospital or clinic) you use at the time.

You pay a monthly premium, which seems simple enough, but different plans include different things, so it’s important to work through this with an advisor who understands the products, and more importantly understands your family’s needs and financial standing. You shouldn’t pay more than you can afford for a plan you won’t use, but in the same breath, you don’t want to go for a plan that simply won’t cover what you need.

The main benefit of having medical aid in place is that it gives you access to excellent healthcare, but it’s important to understand what your medical aid will and won’t cover, what hospitals and doctors you can see, if you will need to pay in a certain amount when you go over and above your monthly premium, and if so, it’s important to find out if you need another product on top of your medical aid in order to compensate for what you might not be able to financially.

There are Gap Cover products available when medical aid schemes don’t cover the full amount, and if you don’t want the surprise of a big financial windfall when something goes wrong, on top of the stress of being ill or having a family member being ill, it might be a good idea to look at adding one of those as a top-up.

There are different plans when it comes to medical aid:

  • Comprehensive – these plans cover most medical costs including day-to-day and in hospital expenses. This means going to the doctor and getting booked into the hospital. These plans provide the most extensive cover. Comprehensive medical aid covers often only offer limited or restricted in-hospital benefits at 100%, 150%, 200% or 300% of the scheme’s rate, and often medical professionals can charge much more than this, meaning that you are still not 100% covered, so you would still need to pick up the outstanding amount or shortfall at the end.
  • Hospital Plans – these plans only cover the cost of treatment while in hospital and do not cover any day-to-day expenses.
  • Hospital Plans with Medical Savings – these plans are a combination of a hospital plan with the added benefit of a savings account that is topped up by your monthly contributions which can be used over the year, and when the funds have been exhausted the member would have to pay themselves, but if there are funds leftover they are carried over to the next year.
  • Network or Capitation Plans – these plans work within a group or network of hospitals and doctors, offering cover for day-to-day or in-hospital expenses which are more cost effective than traditional cover.

There is so much more we could add to this topic, but we don’t want to overwhelm you. Keep an eye out for our next post on Gap Cover.

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

☎️ +27 11 839 2302

📧 info@maysure.za.com

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.

900 491 Maysure Financial Services

Maysure Financial Services: Company Profile

Since 2003 the founders of Maysure Financial Services have believed that life happens – whether we plan it, don’t plan it, save for it, don’t save for it, expect it, or don’t expect it…. It happens. But how your life has happened doesn’t dictate how it must be lived. It is simply a journey that you are on, and everything that you have experienced along the way has brought you to this point, and dictates the road you will take from here on out.

Whether you are at the beginning of your journey, or a long way down the path, a specialised team will help you set a firm financial focus and guide you as your journey continues, specifically when it comes to your retirement and estate planning.

Should you be of the Muslim faith, you will have access to a dedicated Muslim team that understand that your earnings must always remain wholesome and pure, this team will guide you with your Sharia Investments and estate planning so as ensure that your journey is sustained and nourished by that which is Halaal.

We believe that your savings are the first step on your journey to your future – we apply expert, large scale, corporate savings principals to your investments, whilst still maintaining the personal, hands on approach of a small firm.

Maysure Financial Services is built on 3 solid propositions:

Serving you – we want to show you how to take your existing wealth and with some uniquely adapted and personalised guidance, turn it into the ground where your future takes root, the ground where you can start saving towards your dreams, passions and goals.

Services that are adapted to your circumstances – they are inspired by your life. The financial service instruments that we offer are as varied as your journey, and your circumstances will determine which services we will offer you to ensure that your unique financial goals are reached.

An understanding of that which is most important to you – Planning your future financial security should not be taken lightly. Our intention is to make your journey one that ends in financial independence, especially because the path is can be so strongly determined by simple consistency. With the right amount of experience, a firm grasp of the latest technology and a personal, hands on approach, our goal is for you hold the key to financial freedom.

SERVICES

When we are inspired by life to make choices that benefit ourselves and our families, it can be very daunting. This is where Maysure’s expert team steps in.

Our range of financial planning services include:

Retirement Planning
We all dream of being able to spend our time as we choose to. It may seem like an inconceivable notion, but effective retirement planning is exactly that – The process of setting retirement income goals and making the decision to do whatever is necessary to achieve them, in order to live your best life.
Effective retirement planning is essential to ensure that you accumulate the necessary funds necessary to give you financial freedom when you no longer enjoy the advantage of receiving a salary.

Sharia investments and estate planning
Sharia law acts as a code for living that all Muslims should adhere to, and this applies to investments and estate planning too. All earnings are to remain wholesome and pure, and no investments should be used for “sin” industries such as alcohol, tobacco, pornography as well as what can be considered unethical industries such as gambling, arms and weaponry.
Being secure in the knowledge that your investments are Halaal and pure is essential to ensure peace of mind; allowing you to graciously reap the rewards of what you have sown.

Investments – Unit Trusts, Endowments and Tax Free
You can empower yourself greatly by understanding the tax on your savings. Different tax structures apply to different investments and knowing exactly what you have and what you’re going to gain is an integral part of financial planning.
Understanding your investment portfolio is essential to ensure that you really are getting the most bang for your bucks.

Life Cover
Life happens, whether we plan for it or not. Having sufficient life cover ensures that the legacy of love that you leave behind for your family is not tainted by financial worries. Life cover can be reinvested to provide your family with an income and also used to cover any outstanding debt that you may have accumulated.
Ensuring the financial freedom of those you love in the event of your death is essential to ensure that they will not be burdened by financial strain and live the life that envisioned for them.

Medical Aid
Life is a precious gift and a well constructed medical aid ensures that you are able to pay for any treatment expenses incurred with regards to your health and wellbeing, on both a day to day basis and an emergency contingent.
Comprehensive medical aid is essential to ensure that you will not be burdened with debilitating medical bills should you fall ill.

Estate Planning
Your estate is comprised of everything that you own – your car, home, other real estate, checking and savings accounts, investments, life insurance, furniture, personal possessions etc. Estate planning is ensuring that your asset base is managed in the event of your incapacitation or death in an appropriate and financially savvy way.
Estate planning is essential to protect your loved ones, because without a plan in place, there could be a long-lasting negative impact on their future.

Offshore Investing
Offshore Investing allows you to spread your investment risk across different economies and regions. It also gives you access to industries and companies that may not be available locally.
Being strategic with your offshore investment is essential to allow you to make adjustments to your investment portfolio to accommodate the ebb and flow of well performing international markets and maximise your returns.

Fiduciary Services
Being in the position to leave a legacy is a wonderful gift, but it is also a complex one that must be thought through carefully. Fiduciary services help you preserve, grow and distribute your wealth the way you want, both during your lifetime and the lifetimes of your loved ones.
With a thorough fiduciary plan comes financial peace of mind, allowing you to focus on the important things in life – living it the best way you can.

We pride ourselves on a providing a personalised service because we are a small, tight knit team; but our investment tactics and guidance are based on solid corporate principals that are applied across the board, no matter the size of the portfolio.