James White | Director | Sales and Marketing | Turnberry Management Risk Solutions | mail me |
Understanding gap cover misconceptions is essential to ensure you make informed decisions about your medical expenses and coverage.
Today’s consumers are facing more medical expense shortfalls, co-payments, and sub-limits than ever before. As a result, gap cover has become essential for comprehensive medical cover and protection against unexpected financial burdens. However, gap cover does not cover everything. It is crucial to understand how it works to select the right fit for your needs, budget, and current medical aid plan.
Myth: I have comprehensive medical aid, so everything is covered
If you have a higher medical aid plan option, you might assume all expenses are covered. The reality, however, is different. Even on costly comprehensive and executive plans, medical expense shortfalls are common.
Specialists often charge far more than the scheme rate for their services. While comprehensive plans may cover up to 300% of the scheme rate, some specialists charge 500-600% or even more. This discrepancy can lead to significant out-of-pocket expenses. Even with gap cover, this can still pose challenges.
Gap cover typically offers coverage up to 600% of the scheme rate. It is advisable to get a cost estimate from a specialist upfront whenever possible. This ensures you make informed decisions.
Myth: Gap cover will pay my day-to-day medical expenses
Gap cover does not include day-to-day medical expenses. It is important to understand its purpose. Gap cover addresses shortfalls in hospitalisation-related expenses, including sub-limits and co-payments.
Visits to the GP, optometry, and general dentistry, which rely on medical savings, are excluded from gap cover. However, some gap cover plans offer additional benefits. For example, certain providers include a casualty benefit for emergency room visits outside GP working hours.
Myth: If my gap cover policy covers it, I can claim even if it’s not covered by medical aid
Gap cover policies often provide substantial benefits for dread diseases like cancer. They may cover shortfalls when a patient reaches the medical aid’s annual cancer benefit limit. However, gap cover does not cover expenses excluded from your medical aid policy.
For instance, your gap cover policy might include shortfalls for biological cancer drugs. If your medical aid does not cover these drugs, gap cover will not either. Similarly, gap cover may include scopes or scans, but only if medical aid provides partial coverage or the policy specifies it.
Understanding your coverage is essential. Ensure that your gap cover aligns with your medical aid scheme and plan.
Myth: If I make use of a broker, it will cost me money
A broker or financial advisor can help you select the most suitable medical aid and gap cover for your needs. They provide guidance tailored to your age, life stage, and budget. Brokers earn commissions from insurers, so you do not incur extra costs for their services.
Independent brokers bring valuable industry expertise, assisting in understanding gap cover misconceptions and ensuring your benefits adapt to your evolving needs.
