WHEN YOUR MEDICAL AID IS NOT ENOUGH

Why do I need the Gap Cover benefit when I have a Medical Aid? Surely my Medical Aid will cover all my in-hospital expenses?

Not so! The rate at which Medical Aid Companies are prepared to pay for in-hospital procedures and the rate at which the service providers charge are worlds (or rands!) apart.

DOES YOUR MEDICAL AID COVER ALL YOUR HOSPITAL EXPENSES?

If Medical Practitioners charge in excess of the tariff rate at which the Medical Aid reimburses the client for procedures performed in hospital, then the shortfall will be for the member’s account.

More often than not, there will be a short payment on your in-hospital procedures account, due to the service providers charging in excess of what your Medical Aid is prepared to cover. This can in some cases be as much as three or four times the Reference Price List tariff or NHRPL.

Depending on the nature and length of time of your in-hospital procedure, this short payment could be a fairly significant amount, leaving you the end user significantly out of pocket.

An example of an actual  claim is listed below:

Description
Specialist
Cost
NHRPL
GAP Claim
%
Caesarean
Delivery
Anaesthetist
R3770.90
R1482.65
R2288.25
254%
Gynaecologist
R8833.20
R2759.09
R6074.11
320%
Total
 
R12604.10
R4241.74
R8362.36
297%

DON'T GET CAUGHT SHORT ... COVER THE GAP!

COVER THE GAP comes to your Aid with TARIFF GAP and  a range of  Add-On Benefits that offer Medical Scheme members the opportunity to insure against these shortfalls.We do not charge broker fees and are perfectly poised to assist.