What is Gap Cover?

What is Gap Cover?

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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