Mind the Gap

Cura Administrators CEO Rudolph Ackerman explains the broker opportunities in Gap Cover

Rudolph: Thank you for having me and for the opportunity to talk about Cura Administrators and our gap cover product offerings.

There are 3 main areas that differentiates Cura from our competitors.

Firstly, Cura Administrators has been around since 1997 and we have years of experience when it comes to gap cover. We, therefore, have a healthy underwriting surplus.

We have a variety of options available that provides a choice of unique offerings that cater for a wide variety of clients from students, large and small families, and even senior citizens with both open and closed medical schemes.

Most importantly, we have a strong administration team with years of experience and a strong clinical background. This is important as it allows our team to manage claims more effectively as they understand medical procedures and medical scheme rules but also legislation that affects our clients’ rights. There have been numerous occasions that this experience has assisted our clients in overturning previously declined medical scheme claims due to incorrect submissions (ICD10 codes etc).

We place a lot of focus on the quick settlement of a claim, and we are proud to say that in most instances, we can settle a claim within 48 hours if we receive all the necessary supporting documents (Proof of bank account, hospital, and relevant doctor’s accounts; pathology & radiology reports if requested, members medical scheme remittance advice and claim form).

We don’t just sell solutions; we create them.

Tony: There is a lot of talk in the market about Gap Cover, but it is not always well understood. Please tell us, from your perspective, not just a definition, what gap coverage really is.

Rudolph: Gap Cover is an Insurance Product that provides cover for you and your immediate family for the shortfall (Gap) resulting from any Medical Practitioner charging above the Medical Scheme Tariff for in-hospital medical and surgical procedures and even certain out of hospital procedures. In other words, the gap that will exist, resulting from any medical practitioner charging above the medical scheme tariff for in hospital medical and surgical procedures, and even certain out of hospital procedures.

Gap Cover helps you cover those unexpected, exorbitant, out of pocket medical costs, which include co-payments or when healthcare professionals charge more than what your medical scheme pays.

It is important to note, however, that gap cover is not a medical scheme, and the cover is not the same as that of a medical scheme. In other words, gap cover is dependent on benefits covered by your medical scheme. The cover is not a substitute for medical scheme membership. In other words, gap cover is dependent on benefits covered by your medical scheme, the coverage is not a substitute for medical scheme membership, and you must have this benefit with a medical scheme and then the gap cover will kick in.

Tony: What sort of role should, and can the adviser play in making sure that clients understand that there is a benefit in having both, not just having the medical aid itself?

Rudolph: I am happy to say that the industry is finally starting to move away from the word broker and starting to use the term adviser, which I believe is a better description of their role. They really are advisers, as they need to understand the client’s needs, advise them of any shortfalls, and provide them with a basic solution to covering these gaps. They need to provide the clients with the right product at the right time, at the right price, and with the right ongoing support with medical claiming procedures and annual reviews, especially since our health needs change constantly.

Gap Cover is no longer a nice to have, it has become an essential extension to our health cover.

Tony: So, what are the specific regulatory and legislative requirements for a broker to be able to and sell Gap Cover? Where does that fit into their portfolio?

Rudolph: Since the FSCA changed the regulations of the Act, advisers are required to have a recognized qualification. In other words, there are different qualifications, that they recognize but it is no less than an NQF level four. You must be registered with the FSCA as a licensed short-term personal lines broker. This license needs to be renewed annually.

Tony: You explained that you work through advisers, do you work from various locations? Do you have a footprint in South Africa, and do you provide some assistance and product training to brokers?

Rudolph: Cura Administrators has a national footprint across South Africa, and it is essential that we offer continuous product training with annual accreditation.

It is our responsibility to make sure that advisers are always kept up to date with the product improvements and the latest legislation, as these have changed a lot over the last couple of years, especially in the medical scheme industry, so that they are equipped to provide the best support for our clients.

We can be reached on 010 021 0260 or by email at mail@curaadmin.co.za. Advisers and clients can even contact us, submit an application, or apply to become an adviser, via our website www.curaadmin.co.za

In closing, I would like to stress again that Gap Cover is not a nice to have. There is no medical scheme that can say they pay the healthcare providers in full. There is always a gap. If it is not only the tariffs that are more than the medical scheme tariffs, then it is a co-payment or, like some medical schemes call it, a deductible that we cover, with various other benefits. The word “Gap Cover” is not always appropriate as the product often covers more than just the gap with different options, from a basic option to the ultimate cover for a medical scheme member.

I believe that our advisors can do a lot for our clients and each medical scheme member out of the nine million people out there that have medical scheme membership. They should all have Gap Cover, both members of open and closed medical schemes