Michael Emery, Ambledown Financial Services Marketing Executive
Two years of a pandemic and the spike in holiday road accidents have served as a grim reminder that medical insurance is a must-have, to ensure the best possible medical care in the event of an accident or illness.
But often, medical aid schemes do not cover the full costs of specialist and hospital treatment.
Gap cover is a form of short-term insurance that shields you and your family from unexpected shortfalls on medical expenses for in-hospital procedures and specific out-patient procedures, helping avert potential financial catastrophe after a major medical event. Gap cover is not a medical scheme, the cover is not the same as that of a medical scheme and it’s not a substitute for medical scheme membership. Gap Cover is only available to medical scheme members and helps members pay the shortfall that often occurs between what a medical scheme will cover for services and what medical professionals actually charge for services.
Gap cover has become an increasingly important safety blanket, which can achieve a balance between your medical scheme plan and your shortfall medical expenses, as procedure costs rise.
Why medical aid is not enough
Many people discover too late that while their medical aid will cover 100% or 200% (a few schemes will cover 300%) of their tariff for the procedure, the true costs of procedures could be far higher, resulting in a shortfall which the patient or their families must pay.
To keep up with inflation, medical scheme fees go up each year while benefits tend to increase at a lower rate. Co-payments may be increased and limitations placed on specific treatment or procedures. This reinforces the significance of gap cover.
In addition to rising medical scheme contributions and benefits increasing at a lower rate, many people are still experiencing hard economic times and often insurance policies and medical aid is reviewed as a way to cut monthly expenses. Most medical scheme plans allow members to downgrade their plans during the year – but generally, you are only allowed to upgrade at the start of the new year/contract period. If you are changing medical scheme plans to cut costs, make sure you are still covered in the case of any medical emergency and avoid getting into heavy financial stress to cover medical expenses.
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Choosing Gap Cover
Not all gap cover is equal, so it is important to talk to a financial advisor to help you choose a gap cover plan that complements your medical scheme. The right level of cover should minimise shortfalls with gap cover of up to 600% less than the medical scheme reimbursement rate. It should assure members of the latest, correct overall limitation as stipulated by the regulator.
Top end gap cover will also help you pay major medical hospital admission co-payments, and offer cancer cover and dread disease benefits.
In addition to simply covering expense shortfalls, gap cover should be reliable, available when you need it, and should be backed by service excellence and empathetic support.
It is important that gap cover providers are easily accessible to you when you need them most, so look for a gap cover administrator that offers easy registration and claims through online or mobile technologies, and which has a solid track record of paying claims quickly. Ideally, it should allow you to register or submit a claim quickly and easily via your mobile phone and offer access to 24/7 ambulance medical assistance. Additionally, a Covid-19 self-assessment screening and support line would be helpful.
Taking a moment to secure the right levels of medical and gap cover can make all the difference between settling for what treatment you can afford, and the financial security to get the most effective therapy to make a full recovery.
For more information and to find a gap cover solution to suit your specific needs, go to www.ambledown.co.za