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Busting Gap Cover Myths and Misconceptions

Gap cover myths and misconceptions
Discrediting common Gap Cover misconceptions with Total Risk Administrators, revealing its crucial role in complementing medical aid.

Gap cover provides an extra level of financial protection that goes beyond medical aid. Unfortunately, many people misunderstand it, causing them to underestimate its actual value.

Total Risk Administrators (TRA) addresses these misconceptions and highlights the role gap cover plays in your health and safety.

Myth #1: Gap Cover Is Unnecessary If You Have Medical Aid

A common misconception is the belief that comprehensive medical aid negates the need for gap cover. Yet, the reality is starkly different.

Your medical aid does not always cover 100% of the medical costs, especially when specialists charge rates above the standard medical aid tariffs.

Even with a robust medical plan, patients face significant out-of-pocket expenses. This happens when the specialist or procedure costs more than your medical aid tariffs.

Gap cover bridges this financial void, ensuring unexpected medical bills are not burdensome.

Note: Gap Cover is not the same as or a substitute for medical aid, and the cover provided thereunder is not the same.

Differences Between What Your Medical Aid Typically Covers vs What TRA Covers:

Purpose and Coverage
  • Medical Aid: Medical schemes cover healthcare needs like hospital stays, doctor visits, surgeries, and medications. They offer various plans that cater to different coverage needs.
  • TRA Gap Cover: Gap cover is a supplemental insurance policy that covers the difference (or “gap”) between what your medical aid pays and the actual fees charged. It’s particularly useful for covering the shortfall for in-hospital procedures, co-payments, specialist charges, and specific treatments not fully covered by your medical aid.
Cost Structure
  • Medical Aid: Premiums for medical aid plans are typically higher, reflecting the broader range of healthcare services covered.
  • TRA Gap Cover: Premiums for gap cover are generally lower than those for medical aid because they offer a more specific type of coverage. It’s designed to complement your existing medical aid plan, not replace it.
Benefits and Limits
  • Medical Aid: Benefits and limits are defined by your chosen medical aid plan. Plans can include hospital cover, day-to-day benefits, chronic medication cover, and preventative care. Each plan specifies annual limits and conditions for coverage.
  • TRA Gap Cover: The benefits of gap cover are focused on covering the shortfall between medical aid tariffs and actual charges. Benefits are usually capped at a certain multiple of the medical aid rates.
Eligibility and Application
  • Medical Aid: Eligibility for medical aid often requires a thorough assessment of your health status, age, and income. Some plans may have waiting periods for pre-existing conditions.
  • Gap Cover: With fewer restrictions, gap cover is generally easier to qualify for. However, you must be a medical aid scheme member to apply for gap cover. Some gap cover policies may also have waiting periods for specific conditions or procedures.

Myth #2: Gap Cover Is Too Expensive

When weighed against the potential financial risk of uncovered medical bills, the cost of gap cover is a reasonable investment. Consider the financial strain of an unplanned medical procedure without gap cover; the expenses can be daunting.

Total Risk Administrators offer affordable gap cover options, providing peace of mind for a fraction of the cost of potential medical bills. It’s about securing your financial well-being against unforeseen medical expenses.

Total Risk Administrators Plans:

Basic Cover 300 – from R99p/m

Vital Cover Plus- from R300 p/m

Super Cover Plus – from R330 p/m

Absolute Cover Plus from R590 p/m

Myth #3: Gap Cover Is Only Beneficial To The Elderly or Those With Severe Illness

Medical emergencies and unexpected health issues do not discriminate by age or health status. From sports injuries to sudden illnesses, gap cover can be critical for anyone.

Total Risk Administrators sees diverse claims across all age groups, underscoring the benefits we offer our clients.

TRA’s Benefits include:

Basic Cover 300 – from R99p/m

Gap Cover, Casualty Cover, Oncology Gap, Policy Extender, Accidental Death Cover, and TRA Assist Powered by MobiMed.

TRA covers medical treatment shortfalls, emergency treatment, cancer treatment, medical scheme benefits extension, accidental death, and emergency medical assistance.

Vital Cover Plus- from R300 p/m

All Basic Cover Benefits Plus:

  • In Network Co-Payment Cover
  • Sub-Limit Cover
Super Cover Plus – from R330 p/m

All Vital Cover Benefits Plus:

  • Global Fee Benefits
  • Breast Reconstruction Surgery Benefit
  • Co-Payment: Out Of Hospital MRI/CT/PET Scans
  • Out of Network Co-Payment Cover
  • Oncology “New Tech” Benefit
  • In-hospital Maternity Private Ward Benefit
Absolute Cover Plus – from R590 p/m

All super cover benefits with higher limit amounts.

All benefits are subject to an aggregate annual limit of R198,660 (in 2024) per insured person. For more information on our policies and benefits, view our 2024 brochure here.

Myth #4: The Application Process is Complicated and Time-Consuming

Total Risk Administrators understands the value of your time and strives to make the gap-cover application process as straightforward and efficient as possible.

With user-friendly online applications and dedicated customer support, obtaining gap cover is simpler than ever.

Testimonials from satisfied customers highlight the ease of the application process, reflecting Total Risk Administrators’ commitment to customer convenience and satisfaction.

Access our documents as part of our TRA broker toolkit for additional support and information. Read up on our terms and conditions to understand the scope of your coverage.

Myth #5: The Claims Process is Overly Complicated

This may be true of some of the service providers out there! Fortunately, Total Risk Administrators understand the inconvenience of having to complete piles of paperwork to submit a claim and have streamlined the claims process for their policyholders.

While there is certain minimum information required, i.e. provider statement, medical aid statement, and hospital admission confirmation, TRA strives to make the gap-cover claiming process as simple and efficient as possible by offering the following ways to claim:

Read all about the TRA claims process HERE.

Get Gap Cover Clarity With TRA

Uncovering the myths and misconceptions about gap cover is crucial for informed health and financial security decision-making.

Understanding the actual value and benefits of gap cover can ensure that you and your loved ones are fully protected against the unpredictable nature of health-related expenses above and beyond your primary medical scheme.

We are here to guide you through your gap cover options and offer tailored solutions to meet your unique needs.

Don’t let myths and misconceptions deter you from securing the gap cover you deserve.

Contact Total Risk Administrators for more information on the application process for gap cover, or you can apply here.

Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on and matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.


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