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Mossel Bay
12th Aug 2022
Community & LivingNews

WHAT IS GAP COVER?

Gap Cover bridges the gap between your medical bills and your medical aid cover during hospitalisation. It is an insurance product which protects medical aid members from additional unbudgeted costs during hospitalisation. Gap Cover is not a medical aid, does not provide the same cover as that of a medical aid scheme and is not a substitute for medical aid cover.

What is the benefit of Gap Cover?

  • The basic benefit provides cover for the shortfall between medical aid rates and private rates related to authorised in-hospital service provider charges.
  • The cover is limited to a percentage of the original scheme tariff as well as a legislated aggregate per insured person per annum.

What is a medical aid tariff?

  • Most medical aids will cover in-hospital medical costs at a predetermined level, known as medical aid rates or tariffs.
  • This means the medical aid will only pay this pre-determined amount and no more.
  • This is known as 100% medical aid rates and the medical aid has paid to its full level in terms of its registered rules.

What is a private tariff?

  • Doctors (surgeons, anesthetists, physiotherapists, etc.) do not work directly for hospitals but rent the space to perform their in-hospital procedures. This means that they are permitted to charge their own rates for these services.
  • These rates are known as private rates or tariffs. These rates are currently unregulated and providers can charge what they want. 
  • They may even be as high as seven times the 100% medical aid rate mentioned earlier, i.e. 700% of medical aid rates

Many of the benefits offered by medical schemes and Gap Cover providers should be reviewed carefully to ensure that they are best suited for you. Maximise your value by ensuring that your Gap Cover matches the medical expense shortfalls you are likely to need, without spending unnecessary money on features and benefits you don’t require.

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