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Examples of Medical Aid shortfalls
| Procedure | Cost | Medical Aid Payout | Shortfall | Gap Claim |
| Appendicectomy | R3,595.23 | R1,198.41 | R2,396.82 | R2,396.82 |
| Caesarean Section | R10,573.19 | R2,689.80 | R7,883.39 | R7,883.39 |
| Coronary Bypass | R26,376.35 | R13,163.46 | R13,212.89 | R13,212.89 |
| Hysterectomy | R12,977.80 | R4,751.00 | R8,226.80 | R8,226.80 |
| Tonsillectomy | R12,297.70 | R4,119.91 | R8,177.79 | R8,177.79 |
| Wisdom Teeth Removal | R6,260.00 | R1,958.50 | R4,301.50 | R4,301.50 |
What is GAP COVER?
GAP cover pays YOU the difference between what the doctors charge in hospital and NHRPL, what the medical aid actually pays.
The National Health Reference Price List (NHRPL) is a pricing system maintained by the Department of Health and the Council for Medical Schemes. The NHRPL specifies the rates to which your medical aid scheme must adhere. It is the amount of money that they are bound by law to pay out for a given situation. Doctors, hospitals and other medical service providers however, are not bound to these rates, and in fact charge up to 300% above these NHRPL prices. So despite thinking you are financially covered for any medical eventuality in its entirety, for the most part you are not, and are often liable for an enormous shortfall.
So what GAP product will suit me?
Click right here: The Gap Cover from Complimed
