It’s no secret that private healthcare is becoming increasingly expensive for the average South African. With many medical scheme plans failing to provide full coverage for healthcare costs, harder decisions need to be made that can compromise finances or health. As medical aid contributions continue to rise, medical aid members are looking for ways to protect themselves from unexpected medical expenses without breaking the bank.
In efforts to keep monthly premiums lower, people turn to medical aid gap cover to help with the shortfall that might arise on their medical bills. When a medical aid pays less than the total cost charged by healthcare providers, the remaining balance can leave you paying out of your own pocket.
Gap insurance is a supplemental health insurance product, sometimes classified as a short term insurance product, that can often provide extra protection against the high medical costs that your medical scheme might not fully cover. However, there are pros and cons to gap cover that need to be considered before deciding to commit to a plan. TRA is here to guide you along the process and make this choice easier along the way.
Balancing Healthcare Accessibility With Financial Protection
The rising costs of medical treatments and in hospital procedures have undoubtedly led to an increased interest in supplementary healthcare insurance options in South Africa. Medical aid gap cover steps in as a solution that bridges the gap between what is charged and what is then covered, helping to address medical expense shortfalls that can catch you off guard.
Medical gap cover, also referred to as gap insurance or medical shortfall cover, is designed to provide additional financial protection for individuals who are active medical aid members of existing private health insurance such as a medical scheme. Whether you’re facing hospital co payments after common procedures or dealing with specialist fees in rand amounts far above what your plan covers, gap cover can make a meaningful difference.
While this type of insurance can offer valuable benefits, it’s important to weigh both the pros and cons before making a decision.
The Pros of Supplementary Gap Cover
Opting for gap cover is a decision that can save you in the long run, as this form of supplementary health cover works hand-in-hand with your existing medical aid plan to cover the potential shortfalls that can occur. This decision might be a good idea for you or your family under certain circumstances, offering various advantages such as:
Access to Quality Healthcare
While the fear of high medical bills may deter individuals from seeking necessary medical attention, having gap cover in place helps avoid this as it works with an existing medical aid plan. With this, gap cover policyholders have access to quality healthcare providers when they need it most, whether at a hospital, a day clinic, or even a casualty ward during public holidays.
Gap cover can, in turn, help encourage people to prioritise their health by offering them a safety net for costs beyond what their insurance covers, making healthcare more accessible and timely across South Africa.
Financial Protection
One of the well-known primary advantages of medical aid gap cover is its ability to alleviate the financial burden associated with medical treatments that exceed the coverage offered by medical aid schemes. When your medical aid pays only a portion of the bill, the remaining co payments can add up quickly.
Medical procedures, notably those involving specialists and in hospital procedures, can result in rather substantial out-of-pocket expenses and medical costs. Without adequate cover, you could be forced to pay significant rand amounts from your own pocket. Gap cover helps bridge the gap between the amount covered by the health insurance policy and the actual treatment cost, reducing the financial strain on individuals and their families and supporting long-term financial well being.
Peace of Mind
Having medical aid gap cover in place can provide peace of mind to individuals and families in knowing there is an extra added layer of protection for their health and financial security. Some plans even include benefits such as trauma counselling, adding further value beyond standard hospital cover.
This allows them to rest assured that unforeseen medical expenses won’t drain their savings or put them in a precarious financial situation, allowing them to focus on recovery and overall well-being in the bigger picture.
The Cons of Medical Gap Cover
While offering a wide variety of pros, there are certain downsides to keep in mind when considering gap cover. Among these disadvantages, certain points include:
Waiting Periods
With gap cover typically having various waiting periods in place before your coverage will officially kick in and be active, it is important to understand what these waiting periods entail. Many gap cover providers enforce waiting periods that vary depending on the type of procedure or condition.
Be sure to take these waiting periods into account if you anticipate a situation in which you might need immediate coverage, as this can save you both time and money in the long run.
Coverage Exclusions & Limitations
It must be known that gap cover policies have limitations and exclusions depending on the option of gap cover as well as the types of procedures or treatments covered. There may also be various caps on the maximum benefit amounts that are applicable too, which gap cover policyholders should be aware of from the get-go.
It’s essential to carefully review policy terms to understand what is covered as well as if there are any restrictions that may apply. Some pre-existing conditions, as well as emergency services, might also be excluded from coverage depending on the gap cover plan in place. If you are comparing medical gap insurance from one gap cover provider to another, ensure that you look at each plan’s exclusions and limitations. Additionally, familiarise yourself with the claims process so you know how to submit claims efficiently should the need arise.
Is Gap Cover Worth It?
A common question many medical aid members ask is whether gap cover is worth the additional monthly premiums. The answer largely depends on your personal circumstances. When you consider that a single hospital co payment or specialist shortfall can amount to tens of thousands of rands, the relatively low monthly premiums for gap cover can pay for themselves many times over. In most cases, for those who regularly use private healthcare, gap cover is certainly worth the investment.
When To Keep Gap Cover Top-of-Mind
Whilst everyone can benefit from having gap cover in place, certain individuals may benefit from it even more under certain given circumstances. This can include having a planned hospitalisation occurring at some point in the future, such as expecting a baby or planning to have surgery. In these cases, gap insurance could cover hospital costs, including hospital co payments, associated with the medical care you will receive.
Additionally, individuals over a certain age, particularly those over 65, are readily advised to get additional insurance on top of their medical aid contributions, as they are more likely to need common procedures and specialist care. In this way, gap cover can be life-changing, if not even potentially life-saving, in certain situations. Whether you need cover for a day clinic visit or more complex in hospital procedures, having a plan that addresses potential shortfalls gives you greater control over your healthcare journey.
TRA: The Preferred Gap Cover Provider
At TRA, an authorised financial services provider, we understand that everybody’s needs are as unique as their health, budget and personal requirements. With this in mind, we have created various options for gap cover plans to ensure that everybody can be covered to a certain extent and gain peace of mind in ensuring their health.
Total Risk Administrators has different medical gap insurance packages that you can choose from:
- Basic Cover 300, starting at R99 p/m
- Vital cover Plus, starting at R394 p/m
- Super Cover Plus, starting at R417 p/m
- Absolute cover Plus, starting at R681 p/m
Your Cover, Your Choice
Medical aid gap cover can more likely than not prove to be an indispensable addition to your healthcare insurance in assuring you and your loved ones are covered. Working alongside your medical aid plan, this valuable tool helps individuals seeking financial protection against unexpected medical expenses and medical expense shortfalls.
However, like any financial product, it comes with its own set of pros and cons that need to be considered before making a final decision. Before opting for medical aid gap cover, keep in mind what your individual healthcare needs, budget, and potential policy would look like. Understanding the claims process, payments structure, and what your medical aid pays versus what you may need to pay out of your own pocket are all critical factors.
For more information on our medical gap cover policies, have a look at our TRA Gap Cover brochure or explore our website to learn more. If you would like to speak to one of our specialists, contact us to get the process started today.
