Like most people, you have a medical aid to give you peace of mind that if you need medical care for any reason – be it through accident or illness – your bills will be taken care of. After all, who needs to add financial worry to the stress of being hospitalised?
And… like most people, you probably assume that if you have a medical aid, then you’re 100% covered. Unfortunately this is not always true – which is why you need gap cover to ensure that you don’t receivea huge hospital bill if there’s a shortfall between what the doctor charges and what your medical aid will pay for.
What does 100% of the scheme rate actually mean?
If you read the fine print of your medical insurance policy, you’ll see that professional services in hospital are reimbursed at 100% (sometimes 200% or 300%) of the scheme rate. This does not mean that 100% of your medical costs will be taken care of by your medical aid. It means that your medical aid has a list of fair rates for different medical services, and that they are prepared to pay in full according to those rates.
Most doctor’s charges are far greater than 100% of scheme rate
The problem is that in South Africa, there is no regulation as to what hospitals and doctors can charge patients for their services… sometimes actual rates can be as much as 600% of your medical aid rate. And who is responsible for the shortfall? You are, making medical aid gap cover an absolute necessity.
How does gap cover insurance work?
Medical gap cover is not a medical aid. It is a separate policy that your medical aid broker will offer you, to ensure that the shortfall between medical aid rates and actual charges is covered. Essentially, gap cover is an extra monthly payment over and above your normal medical aid fee – but one designed to ensure that you are 100% covered in the true sense of the word. For further information on medical aid and gap cover options, contact us today.
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