In South Africa, medical expenses can be a significant financial burden for many people. That’s why Total Risk Administrators (TRA) offers a range of medical gap products, including Gap Cover.
Gap Cover pays for the difference between what medical specialists charge and what your chosen medical aid is willing to pay. It’s important to note that Gap Cover is not a substitute for medical aid but rather an additional product that can enhance your medical scheme coverage.
In this article, we’ll take a closer look at Gap Cover and how it can help you manage your medical expenses. We’ll explore what Gap Cover is, how it works, and what benefits it offers. We’ll also discuss some important considerations to keep in mind when choosing a Gap Cover product.
So, if you’re looking for ways to enhance your medical scheme coverage and protect yourself from unexpected medical expenses, read on to learn more about Gap Cover.
Why Gap Cover is a Crucial Addition to Your Medical Scheme
Understanding Why You Need It
In the context of South Africa’s rising medical costs, Gap Cover emerges as more than just an optional add-on; it’s increasingly seen as a mandatory aspect of healthcare planning. This necessity is particularly pronounced for families with dependents, where the financial risk associated with medical treatments can be significantly higher.
Gap Cover essentially acts as a financial buffer, filling in the gaps left by your primary medical aid. It pays for the difference between what your medical aid covers and the actual charges incurred, especially in cases where specialists are involved. This cover becomes crucial in instances where medical aid limits are exceeded, leaving you vulnerable to unexpectedly high costs.
The Mechanics
Understanding how Gap Cover operates is key to recognising its value. Typically, medical aids have set tariffs for various procedures and treatments. However, these tariffs often don’t align with what healthcare providers charge. Here’s where Gap Cover steps in – it pays the difference up to a certain limit, ensuring that you aren’t left with a hefty bill.
Importantly, Gap Cover is not a standalone medical insurance. It works in tandem with your existing medical aid, enhancing its coverage. It’s a supplementary cover designed to work in conjunction with, but not replace your primary medical aid.
Benefits
- Financial Protection: The most apparent benefit of Gap Cover is financial. It safeguards against the financial strain that can come from unexpected medical expenses, particularly for treatments or procedures that exceed the limits of standard medical aid plans.
- Peace of Mind: Knowing that you have Gap Cover provides a sense of security. It allows you to focus on recovery without the added stress of financial burden, especially in emergency situations or for high-cost procedures.
- Flexibility and Coverage for a Range of Procedures: Gap Cover policies often include a variety of procedures, treatments, and even certain medications that might not be fully covered under traditional medical aid.
Key Considerations When Choosing Gap Cover
When selecting Gap Cover, there are several factors to consider to ensure that you choose a product that best fits your needs:
- Waiting Periods: Be aware of any waiting periods that may apply to the Gap Cover policy. Some policies may have a general waiting period, while others may have specific waiting periods for certain conditions or procedures.
- Coverage Limits: Understand the limits of the cover. Each Gap Cover policy will have its own set of limits and caps, which can vary significantly between providers.
- Exclusions and Inclusions: It’s crucial to understand what is included and excluded in your Gap Cover policy. Some policies might exclude certain conditions or treatments, so it’s important to read the fine print.
- Cost vs. Benefit: Evaluate the cost of the Gap Cover against the benefits it provides. While cost shouldn’t be the only factor, ensuring that the cover is cost-effective and provides value for your specific needs is important.
Gap Cover is a valuable tool in managing your healthcare finances in South Africa. It provides an additional layer of security over your existing medical aid, ensuring that you and your family are protected from the financial shocks of unexpected medical costs.
Choosing wisely offers peace of mind and financial stability, allowing you to focus on what matters most – your health and well-being.
How can I get Gap Cover with No Waiting Period?
A waiting period on any medical scheme can often prove confusing, and a Gap Cover waiting period is no different.
At Total Risk Administrators, we have tailored our Gap Cover to have no general three-month waiting period. And, if you can provide proof of a pre-existing medical expense shortfall policy, with active membership not longer than 90 days prior, the pre-existing condition waiting periods may be reduced or waived.
For more information and a comprehensive breakdown of the applicable waiting periods, please click here.
What waiting periods are generally imposed on Gap Cover policies in South Africa?
Waiting periods may apply from the policy join date until the specified period is complete. The Gap Cover policy for waiting periods in South Africa can be categorised into four major groups:
General waiting period:
The general three-month waiting period means that you cannot claim or submit a claim for the first three months from the join date on Gap Cover. In most cases, this general waiting period will be waived if the policyholder claims as a result of an accident.
Specified procedure waiting period:
This waiting period is imposed on Gap Cover policies for a specific list of procedures for a certain period, usually 12 months. Operations that involve joint replacement, spinal procedures, scopes, hernia repairs, cardiovascular procedures, and cataract removal are generally included here. This waiting period, once again, may be waived if it is a required accidental injury.
Cancer-related waiting period:
Gap Cover policies may include a 12-month waiting period for pre-diagnosed cancers. This waiting period is calculated from the original join date.
Pre-existing illness waiting period:
Pre-existing illnesses generally include a waiting period of between 6 and 12 months, depending on your provider, unless an accident requires treatment.
How Much Does Gap Cover with No Waiting Period Cost?
Total Risk Administrators offers four different Gap Cover packages tailored to meet your requirements.
These packages include
- Basic Cover 300, starting at R99 p/m
- Vital cover Plus, starting at R250 p/m
- Super Cover Plus, starting at R280 p/m
- Absolute cover Plus, starting at R495 p/m
It is important to note that each package is designed to provide additional coverage over and above what your medical scheme provides. When selecting your Gap cover provider, it is recommended to consider the coverage required rather than just the price.
For more information on the product benefits, please visit the TRA Gap Cover page.
How do I Submit a Claim?
TRA has a variety of claims submission tools, including the online claim tool that can be accessed here.
Other methods of submitting a claim include our Mobile App as well as contacting the claims department directly: https://totalrisksa.co.za/contact-us/
What Our Customers Say
We proudly announce that we rank as a top Gap Cover provider, according to Hello Peter.
Our customer service levels must remain above expectations, and we value individual feedback.
You can look at the TRA Gap Cover brochure if you require more information on TRA’s Gap Cover. For any other queries, contact Total Risk Administrators to speak to one of the qualified specialists today: www.totalrisksa.co.za
