Gap Cover
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.
Go to the BENEFIT SELECTOR CHART now to see where you will fall short.
DOES YOUR MEDICAL AID COVER ALL YOUR HOSPITAL EXPENSES?
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
|
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%
|
