Speak to most people who’ve had a hospital stay and you’ll hear complaints about hefty co-payments or of medical aid schemes not paying the bills.
“Medical aids only pay out 100% or 200% of their own medical scheme tariff (MST) amounts, where doctors and specialists can charge up to 500% of these MST amounts,” says Megan McWilliam, Zestlife gap business development consultant.
Specialists’ fees aren’t regulated in South Africa, and medical schemes have created a cap on the percentage of cover they’ll fund for specialist services. As such, many financial advisors suggest members take out gap cover. But is it worth it? A survey of industry experts suggests it is and increasingly so.
Gap cover is a short-term insurance product which covers shortfalls in the difference between what doctors or specialists charge, and the medical aid’s rate. It covers mainly in-hospital shortfalls but certain out-of-hospital benefits are also funded, including chemotherapy, radiotherapy and renal dialysis.
Top-end product providers may also pay for co-payments on MRI or CT scans, extended oncology cover, trauma/casualty room cover and even counselling.
Gap cover is only available to medical aid members and is relatively inexpensive.
Please contact our Healthcare division for further advice on this essential cover.
This piece has been adapted from a recent article which first appeared in Moneyweb online