The Benefits of Gap Cover in South Africa

The Benefits of Gap Cover in South Africa

In today’s climate, being prepared for the worst is a necessity. Many people wonder, “is gap cover necessary?” and the answer is yes. Medical gap cover in South Africa is something every medical aid member needs to consider and invest in.

Unfortunately, there is no medical gap cover with no waiting period in the market. That’s why we tell our customers to join as soon as possible. Waiting for when disaster strikes, is not a good idea. GapRisk Administrators is a specialist Underwriting Manager that focuses on medical expense shortfall (gap) and co-payment cover for South African medical scheme members. We have three different options available to individuals, families and employee groups, which include GapCover, Combined GapCover, and GapCover Elite.

Here are some of the benefits of each option:

Gap Cover

The in-hospital benefits of GapCover are that it covers tariff shortfalls, dental procedures, as well as back and neck procedures.

  • In the case of tariff shortfall cover, GapCover functions to cover the difference between the amount charged by a Registered Medical Professional and the amount paid out by your respective medical aid. GapCover also covers the Medical Scheme Rate which is for the services received while you were in the hospital.
  • In the case of dental procedures, our GapCover in South Africa functions to cover the shortfall on all these procedures.
  • In the case of back and neck procedures, GapCover functions to cover shortfalls on these procedures.

The out-of-hospital benefits GapCover offers are tariff shortfalls, emergency ward benefits, and physiotherapy.

  • In the case of tariff shortfall cover, GapCover, (not available with no waiting period), functions to cover the shortfall in Gastroscopies and Colonoscopies that have been performed in the GP or specialist’s rooms.
  • In the case of emergency ward benefits, GapCover South Africa functions to cover the shortfall of the costs incurred in an emergency ward by an external force. This payment has to be made by the Medical Scheme.
  • In the case of physiotherapy, GapCover for medical aid members functions to cover out-of-hospital physiotherapy. This physiotherapy has to be for post-operative joint replacement or back surgery rehabilitation.

Combined Cover

The in-hospital benefits of our Combined Cover in South Africa are that it offers tariff shortfall cover, back and neck procedure shortfall cover, and dental procedure shortfall cover in the same way GapCover does. However, in addition, Combined Cover for medical aid members also covers co-payments and deductibles. In the case of co-payments and deductibles, Combined Cover medical top up covers co-payments for procedures performed as an in-patient, hospital admission fees, and specialised radiology.

The out-of-hospital benefits of Combined Cover are that it covers tariff shortfalls, emergency ward benefits, and physiotherapy in the same way that GapCover does. However, in addition, Combined Medical Cover also covers preventative care benefits as well as co-payments and deductibles.

  • In the case of preventative care benefits, Combined Cover covers preventative screening tests such as full blood counts, mammograms, Pap smears, and prostate screening.
  • In the case of co-payments and deductibles, Combined Cover medical aid covers co-payments for procedures performed as an out-patient, hospital admission fees, and specialised radiology.

GapCover Elite

The in-hospital benefits of Medical GapCover Elite are that it offers tariff shortfall cover for back and neck procedures, co-payments and deductibles, and dental procedures in the same way that GapCover medical and Combined Cover in South Africa do. Gap medical cover Elite also covers dental co-payments, a hospital cash plan, non-designated service provider (DSP) hospital co-payments, oncology co-payments, prescribed minimum benefits, and offers shortfall protection from sub-limits.

  • In the case of dental co-payments, Medical GapCover Elite functions to cover the co-payments on all dental procedures paid from risk.
  • In the case of a hospital cash plan, Medical GapCover Elite functions to provide cover if the insured person is admitted immediately to a hospital. The cause of the hospital admittance has to be accidental harm or premature birth.
  • In the case of a non-DSP hospital co-payment benefit, Medical GapCover Elite functions to provide cover for co-payments due to the use of a non-DSP hospital.
  • In the case of an oncology, Medical GapCover Elite functions to provide cover for the co-payment.
  • In the case of a prescribed minimum benefit, Medical GapCover Elite functions to provide cover for non-DSP specialist shortfalls.
  • In the case of shortfalls from sub-limits, Medical GapCover Elite functions to cover the shortfall when a service’s charges have exceeded the benefit’s sub-limit.

The out-of-hospital benefits of Medical GapCover Elite are that it offers tariff shortfall cover, co-payments and deductibles, emergency ward benefits, preventative care benefits, and physiotherapy in the same way that gap cover and Combined gap cover for medical aid do. Medical GapCover Elite also covers accidental dental care needs.

  • In the case of accidental dental care needs, Medical GapCover Elite functions to cover dental reconstruction due to accidental harm or oncology treatment.

In Conclusion

Our gap cover medical aid top up options’ benefits are sure to be the safety net you and your dependents need in tough times. GapRisk is one of the top medical gap insurance companies in South Africa and is ready to offer you gap medical cover that suits your financial situation and needs.