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Gap cover explained: What you need to know

Gap cover explained: What you need to know

Gap cover helps cover medical aid shortfalls, protecting you from unexpected medical bills.
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Sarah, a 35-year-old mother of two, recently needed surgery to remove her appendix. The total account for the procedure, including the surgeon's fees, anaesthetist, and hospital stay, came to R40 000. Sarah’s medical aid covered R25 000 based on the medical aid rates, leaving her with a R15 000 shortfall.

Sarah’s gap cover plan paid the R15 000 difference, which meant she didn’t have to dip into her savings to cover the shortfall. Thanks to gap cover, Sarah could focus on her recovery instead of worrying about unpaid bills.

Bridging the gap when it comes to medical expenses

Gap cover is an often overlooked type of insurance that helps you manage shortfalls in your medical cover. Even with a comprehensive medical aid plan, some treatments cost more than the cover your medical aid provides, leaving you responsible for the difference. Gap cover bridges this financial gap.

Don’t let unexpected medical bills catch you off guard

The rates charged by doctors, specialists, and hospitals often exceed the amounts covered by medical aids. For example, a specialist may charge 200% or 300% of the medical aid rate, while your medical aid might only cover up to 100% or 150%. Without gap cover, you would need to pay the difference yourself, which can be costly.

Gap cover protects you from unexpected medical bills after a hospital stay, surgery, or specialist treatment.

An extra layer of protection

Gap cover works alongside your medical aid plan. It doesn’t replace medical aid; it simply adds an extra layer of protection when medical costs are higher than expected.

How it works:

  1. You receive treatment.
  2. Your medical aid pays part of the bill. Your medical aid may cover 100% of the medical aid rate for the treatment, but the cost of the treatment may be two or three times more than the medical aid rate.
  3. Gap cover pays the difference. If you have gap cover, it pays the difference between the medical aid cover and the cost of the treatment.

If you have medical aid, you qualify for gap cover

Gap cover is available to individuals, regardless of age, and families who are members of a medical aid. Most gap cover plans come with affordable monthly premiums, making it a cost-effective way to protect yourself from large, unexpected medical bills.

While benefits may vary depending on the provider, most gap cover plans include cover for the following:

  • Hospital shortfalls: Pays the gap when your hospital bill exceeds the medical aid rate.
  • Specialist fees: Covers the difference between the specialist’s fee and the amount your medical aid pays.
  • Co-payments: Helps you cover out-of-pocket costs, such as co-payments on certain treatments or scans.
  • Certain procedures: Some gap cover plans include cover for specific procedures, such as dental surgery or cancer treatment.

What gap cover is NOT

  • Not a replacement for medical aid: You must have an active medical aid plan to qualify for gap cover.
  • Not unlimited: Gap cover has limits, so it’s important to check the details of your plan to understand what it covers.
  • Not expensive: Gap cover is designed to be affordable, offering protection without breaking the bank.

Added peace of mind to get the treatment you need

Gap cover allows you to focus on your treatment or recovery without worrying about unexpected medical costs. It’s a smart and affordable way to protect yourself and your finances when you’re left with large bills after a hospital stay or high-cost treatment.

Medical expenses can cause significant financial strain, but gap cover helps ease that burden. By bridging the gap between your doctor’s charges and the amount your medical aid pays, gap cover ensures you’re financially protected when you need it most.

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