The many benefits of Gap Cover

– Tanya Motlafe (Head of Cornerstone Healthcare Consulting Services)

GAP cover has been around for quite some time but it has never been more relevant than now. Medical schemes are under immense pressure to reduce claims and increase savings and as a result, copayments are becoming more and more prevalent.

Having only medical aid to cover your medical costs is simply not enough anymore, you need additional coverage to ensure that you don’t get surprised with a massive medical bill, even after claiming from your medical aid.

Just as the name suggests, Gap cover has been specially designed to cover the gap between medical aid rates and what healthcare professionals charge for in-hospital and out-of-hospital treatments. Many times, medical specialists don’t charge scheme rates which means your medical aid will only pay a portion of the outstanding amount, what about the rest?

Between the progressively unpredictable economy and ever-increasing healthcare costs, Cornerstone Healthcare Consulting Services believes that having Gap cover is an excellent way to fight inflation and help cover shortfalls and co-payments claims. To further highlight the importance of this great medical aid add-on, here are some of our top reasons why you should consider Gap cover.

Private healthcare is becoming more and more expensive

It’s a known fact that healthcare is one of the largest and fastest-growing industries in the world and unlike most other industries, the higher the supply, the higher the demand. South Africa has seen a massive increase in private healthcare facilities over the last few years, yet hospital beds remain fuller than ever. When the demand for high-quality healthcare is this high, the prices of these services will remain equally high.

Another reason for high healthcare costs is the constant influx of new innovations and technology. The medical field is constantly evolving, improving, and developing new treatment options for illnesses.

These developments can include anything from machinery, and medication to surgical procedures and emergency protocols. New technology often provides higher success rates and fewer side effects, it is normally exponentially more expensive than existing or older treatment options.

With this in mind, the possibility of shortfalls in your medical expenses may become higher in the future and could easily add up to six-figure numbers depending on the treatment or procedure. That’s why Gap cover should almost be a non-negotiable add-on to your current medical aid plan. Having a Gap cover policy will cover shortfalls for in-hospital treatments and certain out-of-hospital procedures. Thereby helping you get the best possible medical treatment without breaking the bank.

Great value for money

If you are a medical aid member, you will know those monthly premiums are anything but cheap. The better, more comprehensive plans can easily set you back more than R4,000.00 per month. If you compare these monthly premiums to that of Gap cover, while considering what Gap cover can mean to you and your family, it truly offers extreme value for money.

With many Gap cover plans starting from as little as R200 per month per family or per membership, it is certainly one of the most affordable ways to ensure that you and your loved ones receive the quality care they deserve in times of need. Most Gap cover policies are also fully customisable, depending on your specific needs.

It acts as a buffer if you downgrade your medical scheme benefit option In these uncertain and volatile financial times, downgrading your medical aid plan is often a way
to save some money each month until you get back on your feet or perhaps you are not using most of the benefits on your current plan and a downgrade might be appropriate.

Whatever your reasons, in most cases, downgrading will mean that the percentage that the medical scheme is willing to pay (the medical aid rate) will decrease, thereby increasing the possibility of a higher shortfall.

If you have a Gap cover, it will act as a cushy buffer if you must downgrade to a lower medical aid benefit option, because it will continue to cover many shortfalls that you may encounter.

It covers in and out-of-hospital expenses.

Contrary to popular belief, you do not have to be admitted to a hospital in order to use your Gap cover benefits. Gap cover may cover shortfalls on many out-of-hospital benefits such as accidental casualty, MRI scans, or CT scans.

Although these procedures are mostly performed in-hospital, they are often done without the patient being admitted and therefore it counts as an out-of-hospital procedure.

, ,