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A client phoned in asking if having a medical aid is it enough regarding claims to be paid in full.  I asked the client if she is aware of the term gapcover.  I told the client when you join a medical aid it is very important to know what exactly is covered and what not.  Without proper cover you will have to pay out of your pocket for all medical aid expenses for yourself and your family.

Gapcover is a medical insurance that you can take out extra with your medical aid or your existing medical aid. This means that a member will be protected by covering all short payments, which wasn’t paid in full during any type of hospitalisation or doctor’s visits while in hospital.  Gapcover is only a product for all in hospital treatment and doctor’s visits to the patient while in hospital. Gapcover usually don’t cover dental treatments while in hospital, only  for example impacted wisdom teeth.

Most medical aids only cover up till 100 % medical aid rates.  Your specialists, surgeons and anaesthetists usually charges over and above ( their own private rate ).  It can actually be up to four or five times the recommended rate.

This means that the member is left with substantial short falls which is their liability.  Having gap coverage can help to pay the differences between medical aid scheme’s payment to the hospital and the private rate that is charged by the specialists.  This takes a lot of the stress away from the covered person.

What do you need submitting a gap cover claim ?

  • Completed claim form, signed by the policy holder
  • Details hospital and doctor’s accounts
  • Medical statement as proof of what the medical scheme had paid on the accounts

This takes a lot of the stress away from the covered person.