What is Gap Cover?

When it comes to having medical aid, you need to know what exactly is covered, and how you can go about making sure that everything is covered. This is because health insurance is a very important thing to have. Without the coverage, you will have to pay out of pocket for every medical expense that you get throughout the years for your and your family.

This can cause you to go into debt, and eventually you’re not going to be able to take out loans, credit cards, or anything else that you need a good credit score for since it will go down significantly with the amount of hospital debt that you have. This is why a lot of singles and families should look into gap coverage for their medical aid. First, and explanation of what this insurance coverage is to find out if you need it.

Gap cover is a medical insurance product that can be purchased and added additionally to your existing medical plan. It allows medical aid members to be protected by covering all of their financial obligations when their current medical aid scheme’s payment is short during any type of hospitalisation or doctors visits.

Most of the medical aid schemes cover the hospital costs at a rate of 100% of the applicable medical aid rate. However, a lot of specialists, anaesthetists, surgeons and various other healthcare professional medical providers charge in excess to the recommended rate. It can actually be up to four or five times this recommended rate.

This means that these medical aid members are then left with substantial monetary shortfalls for the payments they need for these services that they received. Depending on the length of your stay in the hospital and the severity of the condition you were seen for, these can severely impact the member’s financial well-being because of the amount of money they will have to pay out of pocket for these services. Their medical plan is not going to cover all of the services depending on who they were seen by and the condition that they were seen for which could cause financial distress.

Having this gap coverage can pay the differences that accumulate between the medical aid scheme’s payment to the hospital or medical facility, and the actual private rate that is charged to the patient. This means that the upper limit is actually four or five times the medical aid rate. This is a lot of money out of pocket without the gap coverage added onto your existing medical aid plan. Not only will you protect yourself from a lot of medical debt, but you can also have the medical freedom of being able to see the specialists that you need without fear of having to pay out of pocket in order to do so. This takes a lot of burden and stress off of the covered person.

If you have a family, gap coverage can cover them as well through their medical aid scheme that they currently have. All you have to do is add it onto the scheme, and then the gap coverage company pays for the outstanding medical bills that are left over after the original medical aid scheme pays their billed amount to the medical facility that you were seen in.