Medical gap cover is a health insurance policy to pay for the “gap” or medical expense shortfalls that may exist between what your medical aid pays and the fee that is charged by a private medical professional. Gap medical schemes are group supplemental health plans that work along with a medical scheme plan to give individuals added peace of mind that their medical expenses will be covered, in essence, additional insurance to your medical aid.
An example of gap insurance
You are admitted to the hospital after an accident or due to illness. Your particular medical aid plan covers 100% of your hospital stay, doctor’s consultations, the anaesthetist’s bill and your medicine. The anaesthetist, however, charges a rate of 200% which creates a shortfall in what your medical aid is willing to pay. If you have medical gap insurance it will cover this shortfall (depending on specific conditions and exclusions) of your medical costs, meaning that you don’t suddenly have to cover the added costs out-of-pocket.
What medical critical illness treatments do gap health insurance cover?
It is important to understand that your gap health insurance only serves as supplementary insurance to your existing medical aid which means that it will cover critical illness treatments that are covered by your medical aid. There is also a nine-month waiting period for claims if a policyholder has been diagnosed with any form of cancer prior to the commencement of their membership.
Total Risk Administrators offers four different Gap Cover packages to choose from according to your requirements:
Basic Cover 300, starting at R99 p/m
Vital Cover Plus, starting at R220 p/m
Super Cover Plus, starting at R250 p/m
Absolute Cover Plus, starting at R450 p/m
Should you need more information on each package, you can have a look at our TRA Gap Cover brochure. For any other queries, contact our Total Risk Administrators specialists today- www.totalrisksa.co.za
Gap Cover Questions & Queries
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 any matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgment 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.