Understanding Gap Cover and How It Can Help You

Medical procedures are expensive – expensive enough to lead to life-changing debt if you don’t have sufficient provision in place. We still encounter many people who doesn’t quite understand Gap Cover as a product – and subsequently they don’t understand how it can help them. In this piece we explain Gap Cover.

What is Gap Cover?

Gap Cover is a short-term insurance policy that provides shortfall for in-hospital treatment where doctors and specialists charge above medical aid rates.

Most people think that if you’re on a medical aid plan, you’re covered for any eventuality. This isn’t quite accurate. Beyond the fact that each medical aid plan have very specific benefits, there are also specific medical aid rates. Medical aid rates are governed by legislation. Even on a good medical aid plan can thus have a shortfall when specialists charge their rates for in-hospital treatments. Gap Cover is becoming a necessity in South Africa as doctors and medical aid practitioners continue to increase their rates.


Who is eligible for Gap Cover?

If you’re South African and registered with a medical aid scheme. If all members of your family belong to your medical scheme and have the same medical aid plan or option, benefits extend to your spouse and children up to a certain age.

Waiting periods and exclusions

Gap cover policies come with certain exclusions and waiting periods, and it is important to familiarise yourself with these before signing up. Your financial advisor can assist you with this.

Most gap cover providers apply:

  • a 3-month general waiting period before a member can claim benefits
  • a 12-month waiting period for pre-existing conditions, which includes pregnancy.

Therefore, if you are planning to fall pregnant it is always a good idea to take out a gap cover policy in advance to ensure that your pregnancy and subsequent childbirth are not excluded from benefits.

Exclusions refer to certain procedures and treatments which will not be covered by your gap cover, any treatment excluded by your medical aid is not covered.

Your gap cover provider should provide you with a detailed list of these exclusions in advance so that you are aware of what treatments and procedures you cannot claim for.

Gap Cover offers increased peace of mind

By insuring yourself and your family against unforeseen medical expenses, you will have peace of mind. If you or your family are hospitalized and a provider is charging more than your medical scheme rate, your gap cover will fund the shortfall and you will not be burdened with large out-of-pocket expenses.

Gap cover closes the gap, ensuring that you can afford the care that you and your family need.

If you are eligible for Gap Cover but you are not yet covered we would be happy to assist you with this process. Please send us an email or give us a call for assistance.

Understanding Gap Cover And How It Can Help You