How gap cover complements your medical aid

by Media Xpose

By Portia Mahlalela, Regional Executive at Alexander Forbes Health

With medical inflation rising annually, gap cover has become a cost-effective addition to cushion the shock of doctors charging more than the medical aid rate for in-hospital services.

Designed to protect against unexpected medical costs, gap cover is a short-term insurance product which bridges the gap between in-hospital medical bills and what your medical aid pays.

Proving that more people are realising the benefit of gap cover, the number of Alexander Forbes corporate medical aid clients with gap cover increased by 5% between 2017 and 2022.

Starting at just a few hundred rand a month, what makes the gap cover premium cost-effective is the fact that it includes the principal member, their spouse, and children until the age of 21. Some gap cover providers allow child dependants to remain covered until the age of 24 if the child is:

  • still registered as a dependant on the main member’s medical scheme membership
  • studying full-time
  • financially dependent on the main member

How it works

As an example: If you have an in-hospital procedure where the total amount claimed is R9 000, the medical scheme rate pays 100% of the medical aid rate, which is R3 000 in this example. This leaves a R6 000 shortfall, which would be covered by gap cover up to yearly limits. The 2022 annual limit ranges from R175 000 to R178 000 per insured.

Like medical aid, gap cover service providers may also impose waiting periods, such as a three-month general waiting period. Claims resulting from accidents may be covered. In addition, pre-existing conditions may have a 12-month waiting period. This is why it is better to be proactive and take out gap cover before something happens.

A healthcare advisor can help you to work out which gap cover policy is best suited for your family’s needs.

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