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Medical Gap Cover: The Pros And Cons To Keep In Mind.

It’s no secret that private healthcare is becoming increasingly expensive for the average South African. With many medical aid plans failing to provide full coverage for healthcare costs, harder decisions need to be made that can compromise finances or health.

In efforts to keep medical aid premiums lower, people turn to medical gap cover to help with the shortfall that might arise on their medical bills.

Gap insurance is a supplemental health insurance product that can often provide extra protection against the high medical costs that your medical aid 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 procedures have undoubtedly led to an increased interest in supplementary healthcare insurance options to be considered for extra peace of mind. Medical gap cover steps in as a solution that does just that, bridging the gap between what is charged and what is then covered.

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 members of existing private health insurance such as medical aid.

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 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, policyholders have access to quality healthcare when they need it most.

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.

Financial Protection

One of the well-known primary advantages of medical gap cover is its ability to alleviate the financial burden associated with medical treatments that exceed the coverage offered by medical aid schemes.

Medical procedures, notably those involving specialists, can result in rather substantial out-of-pocket expenses and medical costs that can rack up. 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.

Peace of Mind

Having medical 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.

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.

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 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, ensure that you look at each plan’s exclusions and limitations.

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 hospitalised 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 associated with the medical care you will receive.

Additionally, individuals over the age of 65 are readily advised to get additional insurance on top of their medical aid, as they are more likely to need it. In this way, gap cover can be life-changing, if not even potentially life-saving, in certain situations.

TRA: The Preferred Gap Cover

AT TRA, 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:

Your Cover, Your Choice

Medical 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 and high medical expenses.

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 gap cover, keep in mind what your individual healthcare needs, budget, and potential policy would look like. 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.

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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