You might believe that you and your family will be sufficiently covered in any event if you have medical aid and medical Gap cover. It is, however, not that simple. Your Gap insurance is inextricably linked to your medical aid and only serves as a supplement to your health insurance policy. Typically, medical aid scheme won’t pay the full rate that specialists and private hospitals charge – which is when Gap insurance will kick in to cover rate shortfalls.

 

Typical Gap insurance exclusions

Gap cover serves as additional coverage to what your medical plan will pay from your hospital or risk benefits. Gap insurance benefits usually have the following exclusions – meaning that your Gap insurance will not provide coverage under these circumstances:

 

  • If your medical aid has not paid a portion of your medical expenses from your hospital or risk benefit.

 

  • Your Gap insurance cannot be used to pay for upfront fees that need to be paid privately.

 

  • Gap insurance typically doesn’t cover accounts related to depression, emotional, or mental illnesses.

 

  • Events involving drugs or alcohol are usually excluded from a health Gap plan unless it’s part of your PMB.

 

  • Any transport charges and/or healthcare services a patient receives when being transported in an emergency vehicle, vessel, or aircraft is excluded from Gap insurance.

 

Be sure to review your Gap insurance policy if you or your family have any pre-existing medical conditions. Pre-existing conditions that may lead to hospitalisation will typically have a waiting period before your coverage will be active. Most Gap policy schedules will have different waiting periods for various conditions – and it’s important to familiarise yourself with this information if you or your family might be affected.

 

Total Risk Administrators offers four Gap Cover packages for you to choose a plan that would suit your needs:

  • Basic Cover 300, starting at R99 p/m
  • Vital Cover Plus, starting at R235 p/m
  • Super Cover Plus, starting at R265 p/m
  • Absolute Cover Plus, starting at R480 p/m

Should you require more information about our medical Gap cover, have a look at our TRA Gap Cover brochure. Contact Total Risk Administrators to speak to one of our specialists if you have any other queries: https://totalrisksa.co.za/contact-us/