Gap cover is a short-term insurance product designed to provide extra protection for those who already have medical aid or a hospital plan. It covers the deficit between your medical scheme’s tariff (MST) and the actual rates charged by private healthcare professionals. Medical aid schemes in South Africa currently reimburse doctors and specialists at 100%, 200%, or 300% of the scheme rate. In reality, however, professional medical providers may and often charge up to five times the base tariff, known as the medical aid rate.
By subscribing to Gap Cover you protect yourself and your family against this financial disparity, potentially avoiding significant out-of-pocket medical expenses. Gap cover can help alleviate financial strain. Even if you have medical aid or a hospital plan, you could be faced with huge medical bills above what your medical aid will cover.
Gap cover works by covering the difference or shortfall between what your Doctor charges and what your medical aid pays from the Risk or hospital benefit. ... Depending on the option you select, you can also have cover for Medical aid Co-payments, Sub-limits and cancer treatment shortfalls.