Gap Cover

My Medical Aid will cover all my in-hospital expenses

Gap Cover: The rate at which Medical Aid Companies pay for in-hospital expenses and the rates charged by service providers are worlds apart. This can in some cases be as much 500% of Medical Scheme Tariffs.

Without Medical Gap Cover you would be personally liable for any payment shortfall that your medical scheme doesn’t cover.

As a medical scheme member you would probably expect your full costs to be covered if you are ever hospitalized. Unfortunately, this is seldom the case. Medical scheme benefits are limited to their Medical Scheme Tariffs (MST) and as we know, medical practitioners can charge considerably more than the MST. Certain medical specialists have been known to charge up to four times the MST. This creates a shortfall — or gap — between the MST and the medical practitioner’s cost. Your medical scheme does not cover this and you are liable for this amount. The actual cost of many procedures performed by surgeons, anesthetists and other medical practitioners can add up to a sizable payment gap.

Protect yourself by reducing your shortfall with Gap Cover. Gap cover is not a Medical Aid, but complement your current Medical Aid.


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