Gap cover essentially helps to cover the shortfalls between what your medical aid pays and the actual costs of medical treatments.
In this article, we compare the offerings from two gap cover providers: Total Risk Administrators (TRA) and Netcare Gap Cover (NetcarePlus GapCare). We will explore each provider’s coverage options, premiums, and additional benefits to help you understand their offerings.
Understanding Gap Cover
Gap cover is supplementary insurance that provides additional coverage for medical expenses exceeding your medical aid’s rates for in-hospital specialist procedures and specific out-of-hospital procedures. This type of cover will protect you from unexpected out-of-pocket costs when faced with a medical emergency.
TRA Gap Cover: Overview and Features
Company Background:
Total Risk Administrators (TRA) is a well-established gap cover provider known for its comprehensive plans catering to various medical and financial needs. TRA is also commended on its client relationships, scoring as a top Gap Cover provider on Hellopeter.
Coverage and Benefits:
- Coverage Above Tariff: TRA provides up to 700% coverage above the medical aid tariff, ensuring that extensive medical expenses are covered.
- Maternity Private ward cover: On the higher plans, the shortfall between the general and the private ward rates for maternity can be covered.
- Oncology benefits: Most of the plans offer extensive coverage for specific oncology treatments, etc.
- Hepstar Travel Benefits: Provides additional coverage for medical expenses incurred while travelling outside South Africa.
- TRA Assist Mobile App: Facilitates easy access to benefits and expedites claim settlements.
- No Maximum Entry or Expiry Age: Offers coverage without age restrictions, making it accessible to a broader demographic.
Premiums:
- Basic Cover 300: From R99 per month
- Vital Cover Plus: From R300 per month
- Super Cover Plus: From R330 per month
- Absolute Cover Plus: From R590 per month
NetcarePlus GapCare: Overview and Features
Company Background:
NetcarePlus GapCare is designed to offer comprehensive protection up to 500% against in- and out-of-hospital shortfalls that medical aid schemes may not fully cover.
Coverage and Benefits:
- In-Hospital Specialist Shortfalls: Covers the shortfalls for specialist fees for in-hospital treatments, ensuring comprehensive coverage.
- Out-of-Hospital Specialist Shortfalls: Provides coverage for specialist consultations outside the hospital, especially for non-network specialists.
- Day-to-Day Costs Beyond Medical Scheme Limits: Covers additional day-to-day expenses that exceed medical scheme limits.
- Co-payments and Deductibles: Includes cover for co-payments imposed by medical schemes for hospital admissions and specific specified medical procedures.
- Maternity Costs and Cancer Treatment: Offers coverage for shortfalls in maternity-related costs and cancer treatments.
- Emergency Medical Treatment: Provides coverage for emergency medical treatment in an emergency department.
- Out-of-Network Hospital Co-payments: Covers co-payments for treatments received at out-of-network Netcare hospitals.
Premiums:
- GapCare: From R299 per month
- GapCare 300+: From R355 per month
- GapCare 500+: From R390 per month
Let’s Sum It Up
For more detailed information, visit the official websites of both service providers.
Coverage for Medical Expense Shortfalls:
- TRA: Offers up to 700% coverage above the tariff, providing extensive protection across various medical scenarios, including both in- and out-of-hospital and a mobile app with Uber trips and embedded travel insurance, oncology benefits, maternity private ward benefits, and casualty benefits.
- NetcarePlus: Provides comprehensive coverage for in-hospital and out-of-hospital shortfalls, including specialised benefits for maternity, oncology, and emergency treatments.
Cost-to-Value Ratio:
- TRA: Offers a range of plans starting at R99 monthly, providing comprehensive benefits for different budget levels.
- NetcarePlus: This provider offers a tiered range of options starting at R299 per month, designed to suit specific needs based on the type of medical scheme and coverage requirements.
Customer Service and Additional Benefits:
- TRA: Known for its excellent customer service and the convenience of the TRA Assist mobile app.
- NetcarePlus: Offers benefits like a premium waiver in the case of accidental death or disability.
Plan Flexibility and Customisation:
- TRA and NetcarePlus offer flexible plans tailored to meet specific medical needs and financial situations. TRA offers extensive coverage options, while NetcarePlus provides a tiered approach that aligns more precisely with medical scheme benefits.
TRA’s Take
TRA and NetcarePlus provide reputable gap cover solutions catering to different needs and preferences.
TRA is perfect for those looking for a lower-cost entry-level product or the option to obtain comprehensive coverage with no age restrictions.
When choosing a gap cover provider, consider your medical needs, financial situation, and desired coverage. Get a quote from TRA today!
