We take out medical aid, pay our monthly premium and just carry on happily with our days believing that no matter what happens, our medical aid scheme has our back. This unfortunately is a fairy tale that is very wrong.

In previous blogs we have spoken about taking out gap cover as a preventative measure to avoid the potential extra costs that your medical aid scheme does not cover, but are you aware of all the ins and outs of gap cover?

Simply put gap cover is…

A plaster to help heal financial wounds, gap cover is a form of top-up insurance that will help shelter you against any costs that your medical aid scheme may not cover. Your gap cover will cover you when your medical savings run out as well as pay you back any shortfall charges that you have had to pay in. If you don’t remember, a shortfall tariff is the amount of money you will need to pay to your healthcare provider if they charge more than your medical scheme covers.

Does everyone need it?

Although this answer is not set in stone, our advice would probably be yes. No matter how comprehensive your medical aid plan is, even if you are on the top scheme that is offered, no medical aid will cover absolutely every medical cost. There are even certain in-hospital procedures that are not covered in full by your medical aid.

What procedures would gap cover help me with?

Gap cover provided by different medical aid schemes do not necessarily always cover the same things so make sure you find out exactly what you are in for before signing on any dotted line.

Some procedures include:

In-hospital treatment:

  • Caesarian section
  • Wisdom teeth removal
  • Coronary bypass
  • Hysterectomy
  • Tonsillectomy
  • Appendicetomy etc.

Out-patient treatment:

  • Shortfall tariffs
  • Chemotherapy
  • Radiotherapy
  • Renal dialysis

We cannot stress enough how important it is to take the time to do your research when choosing a medical aid, as well as a gap cover insurance policy. Needing medical treatment is stressful enough, so why add this extra financial worry on top of everything?