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The Future of Gap Cover

Doctor hi-fiving toddler

In general, we all aim to ensure that our health, and that of our loved ones, is looked after. However, the past few years have shown that there are no guarantees regarding healthcare.

This is where gap cover comes in.

Gap cover covers the in-hospital shortfalls of medical aids when they don’t finance everything a client needs. This cover can be crucial since we can never predict when we will need it most.

Gap cover is quickly becoming a necessity to ensure peace of mind during uncertain times.

Why do we need gap cover providers?

The cost of private healthcare is increasing rapidly due to South Africa’s increasing inflation rate. Also, no South African law governs what doctors can charge, hence the need for gap cover.

According to BusinessTech, South Africans can expect medical aid price hikes due to the costs incurred from the Covid-19 pandemic. This increase means your risk of going into financial debt if you suddenly incur unexpected medical expenses is even greater.

Gap cover presents a spectrum of benefits, especially within the South African context. Gap cover providers step in to provide a well-suited solution to ensure clients across the country are covered from every angle.

As a whole, gap cover goes hand in hand with medical aid, working to cover the shortfalls that occur during your time of need.

Gap cover in South Africa

Public healthcare in South Africa is notoriously understaffed and overcrowded. These issues are because up to 80% of the South African population currently relies on the public healthcare system, making it unreliable during medical emergencies.

Obviously, private healthcare is the safest option in South Africa. But how do you afford private healthcare without breaking the bank? Again, gap cover might be able to save the day.

Whilst gap cover is not a substitute for medical aid, policyholders can select a more affordable medical aid product that doesn’t cover all costs in full and have a gap cover policy with myriad benefits to complement it.

This option is often cheaper than selecting a medical aid that offers premium coverage. Not only will you be saving money, but you also have peace of mind in knowing that you are securely covered in the event of a medical emergency.

Gap cover and Oncology benefits

Most medical aids offer a certain level of coverage when it comes to oncology, after which the patient is responsible for cancer treatment expenses.

Gap cover providers like TRA provide oncology benefits that cover this shortfall. All gap cover benefits are reviewed regularly, and we are constantly considering how best to serve our policyholders in their time of need.

Take a look at our 2023 brochure to see what this benefit entails and how it could help you avoid financial hardship.

Co-payment benefits

Co-payments come into play as a set amount required by a medical aid to be paid by the client themself. The co-payment amount will be fixed for specific procedures, treatments and medical requirements, differing from case to case.

Co-payment benefits vary depending on your gap cover provider and will need to be weighed upon considering who will be offering the service. Co-payments have become more expensive and common due to increasing private healthcare costs.

The ever-increasing cost of healthcare is another reason why it is essential to have a gap cover provider that offers comprehensive benefits.

TRA offers an in-network co-payment benefit for the majority of its products as well as an out-of-hospital benefit for Absolute Cover Plus.

Gap cover and maternity ward benefits

Not all medical schemes cover maternity benefits, but it is crucial for pregnant women to be covered when they need healthcare more than ever.

Maternity benefits include antenatal consultations, ultrasound scans, blood tests, and antenatal classes in some cases. When looking for a gap cover provider to provide maternity benefits, you must note that most gap cover providers apply for maternity waiting periods of around 10 – 12 months.

If you and your partner are considering having children soon, selecting a gap cover policy earlier rather than later is best to ensure that you are securely covered.

What is an annual aggregate limit?

TRA’s aggregate annual limit is currently R185 837, and this amount is subject to change in April 2023.

An annual aggregate limit is a maximum amount a policyholder may be reimbursed for by their gap cover provider. This limit aims to ensure all covered losses are taken care of financially and done so specifically within the space of a given year.

The demarcation regulations decide the annual aggregate limit, which issues a definitive table of figures for determining the annual aggregate limit.

The limit ensures that gap cover providers offer a consistent and stable limit that aligns with South Africa’s inflation rate.

The future of preventive health cover is evolving to merge the benefits of gap cover with the realities many South Africans face. With the expanding list of benefits presented to clients, the choice is getting easier and easier when making long-standing decisions about your family’s healthcare.

Gap cover is becoming a necessity in South Africa, and it is clear that its benefits are becoming more and more relevant in our current economic climate.

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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