Is Gap cover a necessity or a luxury? This is a question I hear from my clients very often. As private healthcare becomes more and more costly, the answer is that Gap Cover is an essential additional to your Medical Scheme.

Many Medical Schemes will cover up to 200% of the Health Scheme rate, if you’re on a more comprehensive option or make use of a specific list of Designated Service Providers (DSPs). Specialists, such as Anesthetists, Cardiologists, Oncologists etc., are now charging between 500% and 800% of the Health Scheme rate. So, where then does the extra cover come from? The answer is YOU!

You have just gone through a procedure in hospital and are still recovering and healing from that, you open your mail and there is a surprise bill for shortfalls that the Medical Scheme couldn’t cover, sometimes in the thousands, and that is just one of the many doctors who attended to you. Its enough to put you straight back into your hospital bed for shock!

This is where Gap Cover fits in. Depending on the plan and coverage, you will submit your bills to your Gap Cover Insurer and never have to pay another cent. There are some providers who offer a “seamless claims process” which means that the Gap Cover will settle their portion of your bills before you even know that there is a shortfall.

As the private healthcare industry evolves there will be more and more co-payments too, on things such as MRI, CT scans etc. Some hospitals require an upfront payment on admission, especially if they fall outside your DSPs. Once again, Gap Cover steps in to save the day.

Gaps covers are constantly changing to fill in gaps in Medical Scheme cover, one of the newest features being day-to-day benefits. Some specialist consultations are now above the Health Scheme rate too, some Gap Covers have added a benefit to assist with this too.

So how do you choose the right Gap Cover to supplement your Medical Scheme? The simple answer is, ask your broker. Brokers undergo training from the Gap Cover Providers, they also have a good knowledge of the Medical Schemes and how the two products work together. As an accredited broker of various Gap Covers we can find the best plan to suit your needs and your budget.