Taking out medical gap cover can prove life-saving, especially when you are admitted to a hospital and risk incurring shortfall costs.
Medical aid scheme rules and regulations can be exasperating and frustrating to follow. Why do our medical aid benefits run out when we need them the most? And why do medical aids cover some medical procedures while others are only partially covered or not at all?
The South African Council for Medical Schemes has suggested a medical aid scheme premium increase of about 5% plus utilisation for 2023/2024, potentially leading to hikes closer to 8.5%. These statistics suggest that South Africans are facing increased financial strain in affording their medical aid, which may lead to difficulties in covering shortfalls.
The need for a Gap Cover is ever-growing, but how do you find the best gap cover in South Africa? How do you differentiate different Gap Cover Options?
Choosing a Medical Gap Cover Provider
According to the latest data released by Statista, in 2022, only 15.8% of all individuals in South Africa were members of medical aid schemes, which accounts for around 9.7 million residents having private medical care. This leaves approximately 84.2% or 52 million people dependent on public health care. It is evident that medical expenses, including having a medical scheme, are a significant financial burden for the majority of South Africans.
Thus, there are many factors that need to be considered when choosing the best gap cover provider. Understand your financial and medical position as a starting point, then follow these 5 tips to optimise your medical cover when comparing gap cover providers.
5 Tips for Optimising Your Medical Aid – Gap Cover Comparison
1. Coverage
First, look for a policy that provides coverage for the specific medical procedures and services that you may require. More importantly, make sure that the policy covers the gap between what your medical aid scheme pays and what your healthcare provider charges.
2. Cost
Consider the cost of the policy and whether it fits within your budget. Then, compare the monthly premiums and benefits of different policies to find one that provides the best value for your money.
Note: When budgeting, note that the cost of gap cover will be separate from that of the medical scheme. Gap cover is not a substitute for your medical aid but rather an add-on should your medical scheme not cover the shortfall in a medical emergency.
3. Provider network:
Check whether the policy covers the healthcare providers and facilities that you and your family prefer or need to use.
4. Limits and exclusions:
Look carefully at any limits or exclusions on the policy to ensure that it meets your specific needs. Some policies may have exclusions for pre-existing conditions, limits for in-hospital and out-of-hospital use, or annual or lifetime limits on the amount of coverage provided.
Note: 2024 sees an overall annual limit (aggregate annual limit) of R198 660 per insured injured person.
5. Reputation and customer service:
Consider the reputation of the insurance company offering the policy and their customer service record. Read reviews from other customers to get a sense of their experiences with the company.
Case Study with Hellopeter Reviews:
Checking the Reputation and Status of Your Medical Gap Cover Provider
In the search for “the best gap cover in South Africa”, we began with an organic Google search, alongside consulting credible platforms such as Hellopeter to hear others’ views and experiences with respect to service issues, claims issues or admin issues.
Even if your provider is not the “worst-rated insurance company”, poor service can lead to a lack of communication, customers being ignored, plenty of stress, and poor insurance ratings. Equally, when claims are not processed properly or not processed at all, the result is a lack of trust in the insurer. Companies that make big, empty promises to no avail quickly lose their standing while racking up poor reviews. Unauthorised deductions, debit orders being duplicated or not going off, suspicious charges, policies not being updated, incorrect details being added to claims, and the like are red flags for anyone searching for a reliable provider.
When it comes to your health, be sure to find a provider who cares, communicates and offers clarity.
Gap Cover Comparison on Hellopeter
Hellopeter is an online platform that connects South African consumers and businesses. It allows consumers to share their experiences with businesses, whether positive or negative and read about other people’s honest experiences with businesses.
Hellopeter proves to be a valuable source of information. Certain insurers stand out in terms of customer satisfaction. However, as of January 2024, Total Risk Administrators is top of the list for Gap Cover in South Africa.
Who offers the best gap cover in South Africa?
Total Risk Administrators (TRA) prides itself on offering the best gap cover plans ensuring the protection and coverage of you and your family.
Best of all, customer reviews from platforms such as Hellopeter, attest to the company’s integrity and efficiency, ranking it #1 Gap Cover in South Africa as of January 2024.
In South Africa, insurance has become almost mandatory to obtain full peace of mind in an emergency, especially when it comes to optimising your medical coverage. Prioritise your health, prioritise your peace of mind and sign up for your TRA Gap Cover.
