WHY GAP COVER

Gap Cover Can Cover Up To 700% Of The Medical Aid Rates For Less Than R200 Per Month.

How Much Worth Is Your Health And The Health Of Your Loved Ones? Should You Not Be Truly Covered 100%?

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how GAP COVER works

Gap cover is the difference between what a medical scheme pays (medical aid tariff) versus the actual cost. Members are then liable for this shortfall. Many private medical practitioners charge in excess of the medical scheme’s in-hospital rate. It is important to note that 100% of the medical scheme rate does not necessarily mean 100% of the cost. Medical schemes may also require co-payments for certain procedures which are payable either by the patient or deducted from a member’s medical savings.

Receive Unexpected Medical Bill

So You Thought Your Medical Aid Would Cover Everything? Then You Receive an Unexpected Medical Bill.

Forward Bill To Your Gap Cover Broker

After Receiving Any Unexpected Medical Bill, No Worries, Just Forward It To Your Gap Cover Broker.

Yay! Done.

Now You Can Relax And Wait For Your Gap Cover Provider To Pay The Money In Your Bank Account Directly, After that You Can Easily Settle The Bill Your Medical Aid Did Not Cover.

GAP COVER Benefits

There Are Endless Benefits With Gap Cover. Depending On Your Individual Specific Needs And What You Can Afford Determines Which Gap Cover Policy Will Work Best.

National Coverage

Your Gap Cover is not limited to specific areas or hospitals, or a particular network of medical professionals such as medical aid restraints.

Protect Your Health

Gap Cover makes it possible to protect you and your family's health. No unexpected shortfalls or medical bills not paid in full.

Secure Fast Payouts

All payments made to your bank account and payout times are very fast and secure.

Innovative idea

7 out of 10 people do not know what Gap Cover is. This is one of the best solutions to ensuring medical expenses covered in full. Many brokers and medical aids do not even inform their clients of Gap Cover.

Save Money

With Gap Cover, you will save much money compared to your total yearly spend on Gap Cover. Medical professionals charge more than the medical tariffs in most cases.

Practical Example

Attending specialist anaesthesiologist Private Rate is R16 612.60 and the Medical Aid Tariff is R4 366.34. If you have Gap Cover, the balance of R12 246.26 is now covered and paid for where your medical aid does not cover the balance.

Gap cover pricing examples

Below Is Nine Different Random Options From Gap Cover Providers From Which We Can Get Quotes. You Need Someone Like Us To Help You Choose The Best Option.

Option 1

R130 pm

  • Gap Cover Percentage 600%
  • Gap Cover Annual limit Unlimited
  • Co-Payment Cover None
  • Sub Limit Cover None
  • PMB Payments None

Option 3

R270 pm per family

  • Gap Cover Percentage 700%
  • Gap Cover Annual limit Unlimited
  • Co-Payment Cover R60 000 per policy per annum
  • Sub Limit Cover R18 000 per event Max R65 000 per policy per annum
  • PMB Payments R60 000 per event

Option 4

R149 pm per family

  • Gap Cover Percentage 500%
  • Gap Cover Annual limit Unlimited
  • Travel Cover R 5 000 000

Option 6

R229 pm per family

  • Gap Cover Percentage 500%
  • Gap Cover Annual limit Unlimited
  • Co-Payment Cover R20 000 per in-hospital admission per insured, including co-payments for MRI, CT and PET scans done in an out-patient facility. Unlimited overall annual limit
  • Sub Limit Cover R10 000 per admission per insured. Unlimited overall annual limit
  • Casualty Benefit as a result of an accident, covers the cost of doctors, radiology, pathology, consumables and treatment in a casualty facility. Limited to R7 500 per admission; unlimited admissions per annum
  • Prostate and breast cancer a once off payment of R10 000 for first diagnosis
  • Personal Accident benefit R20 000 per insured on the policy, covers death and permanent and total disability
  • Travel Cover R5 000 000 per insured with an option to buy up

Option 7

R150 pm per family

  • Gap Cover Percentage 500%
  • Gap Cover Annual limit Unlimited
  • Diagnosis Benefit Once off Payment of R5 000
  • Casualty Benefit covers the cost of your casualty event up to R 5 000 per policy per year
  • Trauma Counselling Benefit covers your consultation fees up to R 5 000 per policy per year

Option 9

R185 pm per family

  • Gap Cover Percentage 500%
  • Gap Cover Annual limit Unlimited
  • Co-Payment Benefit R40 000 per policy per year
  • Diagnosis Benefit Once off Payment of R30 000
  • Casualty Benefit covers the cost of your casualty event up to R 6 000 per policy per year
  • Trauma Counselling Benefit covers your consultation fees up to R 6 000 per policy per year

GET A FREE QUOTE NOW

Please fill in our form below and one of our financial advisors will be in contact to give you an instant quote and options.

FAQ

Got questions? We’ve got answers. If you have some other questions, feel free to send us an email to hello@gap-cover-quotes.co.za

What is a DIAGNOSIS BENEFIT?

  • Our DIAGNOSIS BENEFIT provides a once-off payment when you are diagnosed with cancer for the first time and treatment is required as part of an approved oncology treatment plan.

What is a Casualty Benefit?

  • CASUALTY BENEFIT covers the cost of your casualty event for:
    • Doctor or specialist consultations
    • Basic radiology but excluding specialised radiology such as MRI, CT and PET scans
    • Pathology
    • Disposable items such as surgical gloves, bandages and gauze
    • Medication provided to you as part of your casualty event
    • Upfront casualty co-payments or facility fees

Does Gap Cover pay for medical shortfalls when policyholders are treated out of hospital?

  • No. You have to be admitted into hospital for Gap Cover to cover any medical shortfalls. We only cover service providers that treat you whilst hospitalised and where their related charges exceed medical aid tariff/s.

What is a Prescribed Minimum Benefit (“PMB”) condition?

  • “Prescribed Minimum Benefits is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.
  • PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of:
    • any emergency medical condition;
    • a limited set of 270 medical conditions (defined in the Diagnosis Treatment Pairs);
    • 25 chronic conditions (defined in the Chronic Disease List).
  • When deciding whether a condition is a PMB, the doctor / service provider should only look at the symptoms and not at any other factors, such as how the injury or condition was contracted. This approach is called diagnosis-based. Once the diagnosis has been made, the appropriate treatment and care is decided upon as well as where the patient should receive the treatment”.
  • Policyholders should be well aware and understand their respective medical aid schemes rules around appointed DSP’s and the related protocols when submitting claims that are defined as and relate to a PMB condition.

What is a co-payment?

  • A medical aid co-payment is something that many medical aid scheme members are unaware of until they actually need certain medical services and become liable for this unexpected expense. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services. The medical aid would not cover 100% of the costs and the member would have to pay a predetermined fixed amount or a certain percentage of the medical service obtained before the medical aid pays their portion.

What is sub limit cover?

  • Most medical aid schemes impose “sub limits” on certain in hospital procedures. There may be a sub limit imposed on internal prosthesis e.g. pins and plates as part of a back operation or heart stents.

Is there a time limit as to when claims can be submitted?

  • Valid claims must be submitted and received by Gap Cover within 3 months from the date of processing of such claim/s by the policyholder’s medical aid scheme.

How long do you take to refund the gap cover portion?

  • Valid and approved claims are processed and paid every Saturday.

Does Gap Cover pay the doctor’s directly?

  • With the proposed amended legislation Gap Cover will be able to pay the doctors directly. This will only be implemented once the new regulations become law. In the interim claims will be refunded into the policyholder’s nominated bank account for them to then settle the outstanding amount directly with the doctor.

meet the team

We Are A Small Group Trying To Help More People Get Gap Cover And The Right Gap Cover As We Ourselves Have Seen The Benefits.

Dewaldt Huysamen

Marketing & Operations Manager

Johnny Huysamen

Financial Broker

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