Gap covers and its benefits

Rachel Janssen, the principal consultant at Alexander Forbes Health shared the benefits of having the Gap cover. What is a Gap cover? It is a short term insurance product which covers financial shortfalls during the hospital stays especially when the health care professionals charge more than the actual medical scheme rate. The ones on the higher medical aid plans also may still have gaps between their med scheme reimbursement rate and what the service providers charge. The tariff gaps are when the benefit of gap cover drops by. Even with a good medical aid plan, the shortfall of this can cost thousands of grand.  And being covered by your medical aid at 100 % of the medical scheme rate does not mean that you are complete covered. Practitioner fees are usually unregulated and they might charge more for their services than the rate which was initially fixed or the ones which your med scheme covers. So the medical scheme members therefore experience shortages when a surgeon or anesthetist or any other service providers charges above the preset med scheme rates. The shortage or the gap is the actual cost which is charged by the provider which exceeds the medical scheme tariff.

Certain procedures like radiology scans and oncology claims entice co-payments which fees not covered by a medical aid or the upfront payments to providers. Gap covers can also offer additional benefits for cancer procedures, these once off benefits may also apply for the first time diagnosis, accidental deaths or accidental or permanent disabilities as well.

Gap covers can also serve as a bridge in cover if there is a downgrade in the medical aid option for a more affordable and less comprehensive option. Members often consider decreasing their medical plan to a more affordable one, to reduce the medical scheme contribution there is an option to downgrade which covers 300 per cent of the med scheme rates in the hospital to a plan which covers you at 100 per cent of med scheme rates at a reduced premium.

By protecting yourself and your family against unexpected medical expenses, you will have peace of mind. If you or your family are ever hospitalized and a benefactor is alleging more than your medical scheme rate, your gap cover will fund the shortfall and you will not be loaded with large amount of expenses.

It is very important to take the appraisal of the various gap products which are accessible, as not all welfares are identical. Make sure you distinguish what rate your gap cover benefactor will cover you up to, as some products will cover you up to five times the medical scheme rate and some only two times. They come with wide ranging remunerations for the whole family. Communicate with your healthcare consultant if you are thinking of adding gap cover insurance to your portfolio.