Gap Cover 101 – Moneyweb

As thousands of South Africans find to their horror every year, having medical aid doesn’t mean you’re 100% covered for hospital procedures. There’s often a big difference between what medical specialists charge and what medical aids cover, and it can often leave you with an expensive headache that lingers long after the pain of the procedure has receded.

This is where gap cover plays an important role. Gap cover is a short-term insurance product which bridges the gap between all the actual costs of the medical expenses associated with the procedure and the medical aid payment. It is an effective way to ensure that you are covered for unforeseen in-hospital shortfalls.

How does Gap cover work?

Usually, purchased separately from your medical aid, gap cover has been around for many years. Now, with the cost of medical services often exceeding the re-imbursement rate at which your medical aid covers members, it is growing in popularity among South Africans looking to protect themselves from large shortfalls and soaring medical costs, says Gary Feldman, Executive Head of Healthcare Consulting for employee benefits firm NMG Benefits.

“Gap cover doesn’t replace comprehensive medical cover, but it complements it. It should no longer be seen as a luxury: it’s an absolute necessity to make sure your family or your employees are not left financially ruined in a medical emergency,” says Feldman. “Gap cover offers people peace of mind and should no longer be ignored.” People should not wait until they need to be hospitalised and then think they can take out gap cover, pre-existing conditions can be excluded for up to twelve months.

Who can buy gap cover?

It sounds obvious, but you can only buy gap cover if you’re a member of a registered medical aid scheme. The good news is that it’s relatively affordable and can be purchased at any time through the provider of your choice. Not all providers offer the same benefits, though, so it could be in your best interests to speak to a healthcare consultant to ensure you buy the right gap cover for your particular circumstances.

This is also important for employers, who need independent, unbiased, tailored strategic advice on gap cover that best suits their employees’ needs. “Remember that gap cover does not need to be compulsory for all employees. You can offer it to your employees, let them know how important it is, and give them the opportunity to take it as part of their total cost to company,” says Feldman.

Gary Feldman, executive head of healthcare consulting for employee benefits firm NMG Benefits.

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