Gap cover is an additional medical aid product that is specifically designed to cover the shortfall between traditional medical aid scheme rates and what the health care providers actually charge while you or a family member is in hospital.
The cost of the product, which can be anything between R55 and R150 per month, is an affordable hedge against ever increasing medical costs.
Although the most popular gap cover product is tariff gap cover, there are a variety of gap products available across medical aid schemes – co-payment, cancer sub-limits and combo gap products.
Benefits of Gap Cover
Although the National Health Reference Price List or NHRPL provides a rates guideline for medical procedures, diagnoses and operations conducted in South Africa, it very rarely reflects the actual rates charged by medical professionals.
The deficit between what your medical aid is prepared to cover and the actual tariffs can be significant, leaving you seriously out of pocket.
Gap cover provides generous benefits that can be as much as R100 000 per year for each beneficiary and R200 000 per annum for the entire family, up to 400% of the NHRPL amount!
Who Should Apply For Gap Cover?
Many comprehensive and hospital plans provide cover at 100%, 150% and 200% of the NHRPL rates for hospitalisation only, while it is not unusual for health care professional to charge over four times the rate.
Any South African whose medical aid does not pay the full cost in hospital should consider additional gap cover.
Gap Cover Products
Typical gap cover products available in South Africa include:
- Tariff Gap Cover– provides additional cover for specialists in hospital, up to 400% of the scheme’s rate.
- Co-Payment Gap Cover– may only be taken in conjunction with a tariff gap cover product and offers cover for any co-payment or deductible amount in hospital, and includes additional benefits such as cover for co-payments on CT and MRI scans, radiotherapy and kidney dialysis out of hospital.
- Cancer Sub-Limits Gap Cover– provides cover for any co-payments enforced by your medical aid scheme, should you or a family member exceed the prescribed oncology benefit limit.
- Combination Gap Cover – offers a combination of co-payment gap cover and cancer sub-limits gap cover at a reduced rate.