What is Gap Cover?
Gap Cover is basically an additional insurance product that is available to all medical aid members. This short term insurance provides additional funds to in-hospital medical procedures that would otherwise be the responsibility of the medical aid member.
The medical aid scheme options that you belong to might cover 100%, 150% or even 200% of the medical scheme tariff. In some cases, you might be charged up to 500% for in-hospital procedures by medical service providers. This is when Gap Cover comes in, which actually pays for the shortfall that you, as a medical aid member, might have had to pay out of your own pocket.
As a Gap Cover policy holder, you are covered for up to 500% of the cost between what your medical aid scheme is willing to pay and the cost of your doctor’s rate.
Why do you need Gap Cover?
Gap Cover is a medical aid shortfall solution. It is an affordable way to make sure that you don’t pay for in-hospital procedures out of your own pocket again.
Who can get Gap Cover?
- The medical aid principal member with all his/her dependents with a maximum age of 70 years
- Gap Cover covers the principal member, spouse / life partner, biological or legally adopted children that is listed on the principal member’s medical aid policy
- Only members that is registered on the principal member’s medical aid policy is covered
How and when does Gap Cover pay out?
- Gap Cover can only be applied in hospitals, day-clinics or even unattached operating theatres where associated medical services is provided
- The Gap Cover funds are only payable to the principal member of a registered medical aid scheme
- The policy will be paid to the principal member if such principal member and his/her dependants is not subject to any exclusions as per the principal member’s policy contract or if no underwriting applies
- As a Gap Cover policy holder you must make sure that you understand and are familiar with your medical aid scheme’s limitations and exclusions list as your Gap Cover policy does not cover procedures that is not covered and payable by your medical aid scheme (i.e. if your scheme does not cover a procedure, the Gap Cover policy won’t either)
What does it cost?
- Gap Cover = R135 per month per family (max annual cover or R1 million)
- CoPay Cover = R70 per month per family (limited to R10 000 per event)
- Gap Cover + CoPay Cover (combined cover) = R185 per month per family
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