Who Needs Medical Aid Gap Cover? | Dis-Chem Health

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Who Needs Medical Aid Gap Cover?

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If you have medical aid, it’s natural to assume that all your medical bills will be taken care of right? That might not always be the case, since some medical aid plans are unable to cover the full cost of certain procedures and treatments. That is what makes Gap Cover so important. The only problem is that many of us don’t know about the power of Gap Cover, or if we even need it.

That is where Info Hub comes in! With this quick guide, we would love to help you understand how Gap Cover works and more importantly, how it can work best for you.


What is Medical Aid Gap Cover and how does it work?

To put it simply, Gap Cover is a tool that you use to protect your pocket from the bills that your medical aid is unable to pay. The main hospital bill Gap Cover is used for is when a specialist doctor charges more for a procedure than what your medical aid covers, creating something called a shortfall. In a normal case, you would be one covering the shortfall from your own pocket. But if you have Gap Cover, you could use it to pay the rest of that bill.

Examples of when medical aid gap cover can bridge the shortfall include hospital procedures like C-sections, tonsil removals and surgery just to name a few. Many Gap Cover plans will also have benefits like Sub-Limit shortfall cover, as well as Co-Payment and Deductibles shortfall cover. This is all industry talk that ultimately describes one main thing: The unexpected bills caused by a shortfall, can be taken care of with Gap Cover. While benefits like this make Gap Cover a very useful tool, it’s important to remember that there are limits and exclusions.


Who needs Medical Aid Gap Cover?

A big group of people who need medical aid gap cover are those that could have a serious medical procedure in the near future. If you were unfortunately diagnosed with cancer for example, you may need a lot of medical assistance. Some Gap Cover plans have benefits that deal specifically with shortfalls that happen with cancer treatment, making it a tool worth having. If you have loved ones as dependents on your medical aid, Gap Cover could help in covering their medical expenses too. If they needed a CT scan after an injury for example, most medical aids will require you to pay that fee upfront (This is known as a Standard Co-Payment). What Gap Cover allows you to do is claim back the money you spent, meaning your pocket isn’t compromised in the long run.  

It might sound like Gap Cover is mainly for people with serious health problems, but healthy people need it too! This is because it’s hard to know when you will need medical treatment, since accidents do happen. Some of the average ages of claims Insurers have seen are as low as 21, so it’s a really useful tool to have if you ever need it. 

Many plans also tend to charge lower premiums if you are younger. It’s understandable that this might feel like an unnecessary expense if you’re starting your career or business. But if you already have medical aid, you could be paying less than R300 per month for Gap Cover. Considering the level of protection you can get with a plan, it’s safe to say anyone with medical aid is someone who needs medical aid gap cover. 


The benefits of having Medical Aid Gap Cover

As terrible as it sounds, we must admit: Being sick is expensive. When serious medical procedures need to be done, so many things need to happen to make sure everything goes smoothly. From the equipment, time spent by the specialist, medicine and more, it’s easy for medical bills to pile up. Things become scary if you’re not on a premium Medical Aid scheme, because it won’t be long until you’ve reached the limits of your plan. Gap Cover can handle some of the bills that the medical aid is unable to, allowing you to save as much as you can.  

This also gives you the power to make the decisions you want to with your health, without worrying about finances. Many people who need medical aid Gap Cover for example, spend years having issues with their tonsils because the shortfall cost of removing them seems too much. If having Gap Cover means you won’t be paying out-of-pocket for a procedure like this, taking care of those tonsils becomes much easier. All in all, the protection Gap Cover gives you is the one thing that so many insurance companies promise: Peace of mind. 


The different types of Medical Aid Gap Cover policies

The main factor that influences different types of Gap Cover policies is the scope of the benefits. While benefits differ from company to company, most standard plans include shortfall cover for tariffs and sub-limits. Some plans cover shortfalls from standard co-payments and deductibles, or even shortfalls that come from cancer treatment. Plans like this usually give you much more protection against shortfalls, but they tend to be more expensive compared to standard plans. Some plans may even have optional benefits that you can add like family counselling and shop discounts. It’s important to check the available policy documents, for a better understanding of what makes the policies different. 


How to choose the Best Medical Aid Gap Cover policy for you

We mentioned that when it comes to the different types of plans, the main influence is benefits. It’s also one of the factors that you can use when choosing the best Gap Cover policy for you. But don’t just look at the list of benefits – also think about the limits and exclusions on those benefits. They may be different depending on the plan you choose, so it’s important to know exactly what you’re covered for. 

With terms like tariff shortfalls, sub-limits, standard co-payment and deductibles, it can be difficult to understand what your benefits actually are! What is usually easier to understand, is the procedures that are covered under these terms. Does the plan cover shortfalls for procedures like childbirths, tonsil removal or basic dentist procedures? Does it cover in-hospital as well as out-of-hospital procedures? These are some of the questions you can ask, when choosing a gap cover policy for medical aid. If possible, contact a registered broker and talk to them about the options you’re considering. Advice from a professional always helps in making the best decisions. 



That’s it for this article! If you were wondering whether you’re someone who needs Medical Aid Gap Cover, we hope this article has helped to answer that question.  If you would like to learn more about Gap Cover, check out our most popular articles below. 

Not all Gap Cover plans are the same and benefits as well as limitations may vary. Descriptions of benefits given are meant to be for general educational purposes only and you must ensure that you seek the advice of a broker to ensure any product choice you make suits your individual needs 

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