In some instances, the amount that your medical aid plan is willing to pay out for a medical procedure will be less than what a health practitioner charges – especially if you’re using a provider outside of your medical scheme’s network. In this case, the shortfall between your medical scheme’s tariff (MST) and the provider will need to be paid in yourself, known as a co-payment. Medical aid gap cover is short term insurance coverage that is completely separate from medical aid, and covers a portion of the co-payment that you’re responsible for.
Gap cover is designed for people who already have medical aid in place, so you can’t get a policy without having a pre-existing medical aid cover. There are many different gap cover providers in South Africa, all of whom provide different levels of cover. Some of them may cover things like hospital admissions, surgical procedures and medical scans, as well as outpatient expenses for up 500% of the MST. Others have cheaper premiums but offer a lower reimbursement percentage, and for fewer medical expenses.
You can apply for medical aid gap cover if you are under 60 years old and are already a member of a medical scheme. As with medical aid, there’s also usually a waiting period for joining gap cover and receiving all benefits. There’s also usually around a year’s waiting period for pre-existing conditions, during which time you won’t be able to claim.
Even if you have medical aid, you could be faced with huge medical bills to pay in over and above what your medical aid will cover. For these cases, gap cover can help alleviate the financial strain – especially for large medical expenses in the case of a serious illness or accident.
DISCLAIMER: The information on this website is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional.