Glopin Healthcare Consultants has noted a recent increase in members who are overwhelmed with unexpected medical costs. If the last year has taught us anything, it has emphasised the importance of having access to private and quality healthcare, without any additional financial stresses.
Although being a member of a medical scheme, often, your medical expenses will exceed your medical aid rate. The shortfall would then become your out-of-pocket expense. Unexpected medical costs arise when healthcare professionals charge more than what your medical scheme pays or when you have a life-changing event or emergency and often when members do not utilise the designated network of service providers.
Glopin Healthcare Consultants strongly recommends that members acquire Gap Cover. Gap Cover is an important consideration in South Africa, where private healthcare rates, and medical inflation, often increase faster than other household expenses and could become unaffordable. Medical Aid Gap Cover covers the gap between what a health practitioner charges for in-hospital care and the amount your medical aid is willing to pay.
The Council for Medical Schemes recommends an annual medical aid rate which is the base rate that can be charged by all medical practitioners, including those who provide in-hospital and out-patient medical procedures. Many of the medical schemes abide by paying a percentage of this rate and depending on the medical aid package will pay up to 300% of this rate. The problem arises because medical practitioners are permitted to charge what they deem necessary for their services and often charge higher than the medical schemes recommend. Gap Cover will help to bridge the shortfall between what your medical practitioner charges and what the medical aid is willing to pay for when you are admitted to the hospital.
Gap Cover is insurance that provides cover for expenses your medical aid does not pay in full, which could relate to hospitalisation for accidents and illness or medical procedures such as chemotherapy, radiotherapy, oncology, and joint replacements.
Any main member and their dependents who are registered members of a medical aid scheme are eligible for Gap Cover. It is basically a medical insurance policy that works on the principle of boosting your existing medical aid coverage. There could be a maximum 12-month waiting period for those with pre-existing conditions and, it is advisable to speak to your broker as some impose a higher premium for those above the age of 60 years.
Gap Cover is an insurance product and, depending on the cover taken, will cover the costs for treatment or care when medical aids only pay a portion. Gap Cover policies and prices vary. Premiums are based on the individual’s circumstances and are in line with short-term insurance and long-term insurance pricing principles.
Prevent incurring stressful medical expenses by speaking to a Glopin Healthcare Consultant who will advise on the best Gap Cover options for you and your loved ones.
