Gap cover is here to stay and more important than ever! I’ve just received a doctor’s account 10 times what the medical aid is prepared to pay! Over the past few years we’re seeing an increasing number of significant GAP Cover claims which is re-enforcing the importance of having this type of cover. Not sure what it is, read on…

It’s only after you’ve spent time in hospital that you find out that the cover provided by your medical aid has fallen short of the amount charged by the medical professionals that attended to you. This leaves you with a significant excess to pay that you simply didn’t budget for.

  • This portion of your medical bill, often being a large amount that you need to pay, is referred to as the gap between what your medical aid has paid out and the actual cost of treatment you receive.
  • Having said this, it arises for a very simple reason: In order to provide an efficient service to its members and keep control over expenses, a medical aid needs a set of guideline prices to base its benefit payments upon.
  • Most medical aids use the National Health Reference Price List (NHRPL), which is published by the Department of Health and is used to determine the reasonable cost of healthcare services in South Africa.
  • Medical professionals (such as surgeons and anaesthetists) are not obliged to follow these recommended rates and often charge more for their services than the guidelines provided for by the NHRPL. Sometimes as much as four times over!
  • Therefore, since most medical aids pay claims at the rates suggested by the NHRPL, you’ll agree that the gap that results will leave a sizeable gap in your pocket.

Bridge the Gap!

Medical Gap Cover fills the gap between what your medical aid has paid and what medical professionals have charged, in some instances an additional five times NHRPL. Given that most medical schemes only cover you at NHRP, this is a major boost to your in-hospital cover!

As the need for Gap cover has increased we’ve seen a growing number of Insurers introducing their own products to the market. Currently there are around 100 options to choose from making the decision a difficult one. To help you choose from all the options we’ve selected 5 of the most reputable insurers and compared their most comprehensive option. For a comprehensive comparison of these options click on the link Wellspent.co.za

Feel free to email us if you have any questions.