03 March 2023
Gap cover in South Africa is a type of insurance product that provides additional financial protection for medical expenses that are not fully covered by your primary medical aid.
Even with a medical aid, you may still be responsible for certain out-of-pocket expenses such as hospital co-payments, deductibles and fees for medical specialists that exceed your medical aid’s rates furthermore, Gap Cover is designed to help cover these additional expenses, so yo
u don’t have to pay for them out of your own pocket.
A report published by the Council for Medical Schemes (CMS) in 2021 states that the total out-of-pocket payments by medical aid members increased from R29.8 billion in 2016 to R36.7 billion in 2021 at a consolidated scheme level including both open and restricted medical schemes. Moreover, this equates to 23% more out-of-pocket expenses paid by members from 2016 to 2021.
Having gap cover does not mean that all out-of-pocket expenses will automatically be covered, as this is a misconception throughout the industry which leads to frustration and confusion from gap cover policyholders.
Gap cover polices are not designed to cover day-to-day shortfalls namely, medicine, GP visits, and charges once your medical savings account has been depleted.
It is designed to cover in-hospital treatment and procedures and certain defined out-of-hospital procedures.
The table below contains some common procedures that frequently result in medical expense shortfalls additionally, the Rand amounts that were not covered by the medical aid and required payment by the member. These are actual Zestlife Gap Cover claim amounts paid during 2021/2022:
It is highly recommended that you choose the right gap cover option to suit you and your family’s needs and budget.
Contact us today and we will gladly assist you.
Click here for more product information or to apply online.