Medical Gap Cover Comparison

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If you have medical aid, you may think you’re fully covered for all medical expenses. But the truth is, there may be certain medical treatments that are not fully covered by your medical aid, leaving you with out-of-pocket expenses.

That’s where medical gap cover comes in. It is an insurance product that covers the gap between what your medical aid pays and the actual medical costs incurred. In this article, we’ll compare medical gap cover companies in South Africa.

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Compare Medical Gap Cover Companies in South Africa

Auto & General Medical Gap Cover

Auto & General Medical Gap Cover

7.6
  • Offers three plans to suit various budgets.
  • Easy online quote application process.
  • Remarkable customer service.
     
Old Mutual Medical Gap Cover

Old Mutual Medical Gap Cover

4.02
  • Premiums start from R225 per family, per month.
  • Get covered for shortfalls on your existing medical aid scheme.
  • Four core benefits, with a maximum payout of R169,000 per member.

What is the Purpose of a Medical Gap Cover Insurance?

The purpose of a medical gap cover is to provide additional financial protection for medical expenses that are not covered by your medical aid.

For example, if the insured medical scheme only covers a portion of the cost of a medical procedure, a medical gap cover policy can help cover the shortfall. This can help prevent you from having to pay a large sum of money out of pocket.

Factors to Consider When Comparing Medical Gap Cover Companies

When comparing medical gap cover companies, there are several factors to consider:

Price

First and foremost, you should consider the price of the gap cover policy. This includes both the monthly premium and any excess or co-payment that you may need to pay.

Be sure to compare the costs of different policies to find one that fits your budget.

Coverage

You should also consider what is covered by the gap cover policy. Some policies may only cover specific medical treatments or procedures, while others may have exclusions for certain conditions.

For example, it might only cover in-hospital procedures, leaving you to pay the bill on out-of-hospital expenses that regularly occur.

Limits

It’s important to check for any limits on the gap cover policy, such as annual or lifetime limits. Some policies may also have limits on the amount that they will pay for certain medical treatments or procedures.

Waiting Periods

Be aware of any waiting periods that may be associated with the policy. Some policies may require you to wait a certain amount of time before you can make a claim.

Exclusions

Check for any medical conditions or procedures that are excluded from coverage. This can vary from policy to policy.

Service Provider Networks

Some policies may only work with specific service providers, while others may offer freedom of choice. Make sure to consider this when choosing a policy.

Benefits of a Medical Gap Cover

Medical gap cover can provide numerous benefits to individuals who have existing medical aid cover in South Africa. Some of the key benefits include:

  1. Increased coverage: Medical gap cover can provide additional coverage for medical expenses that are not fully covered by your existing medical aid plan. This can include co-payments, deductibles, and other out-of-pocket expenses.

  2. Lower healthcare costs: By covering expenses that are not covered by your medical aid plan, gap cover can help reduce your overall healthcare costs. This can be especially important for individuals who require ongoing medical treatment or have chronic conditions.

  3. Peace of mind: Knowing that you have additional coverage in case of unexpected medical expenses can provide peace of mind and reduce financial stress.

  4. Access to more medical providers: Some medical gap cover plans offer access to a wider network of medical providers and specialists, which can improve the quality of care you receive.

  5. Flexibility: Medical gap cover plans can be tailored to your specific needs and budget, providing flexibility in terms of coverage and cost.

Overall, a medical gap cover plan can provide a valuable safety net for individuals with existing medical aid cover in South Africa, helping to ensure that they have access to the healthcare they need without incurring excessive costs.

Disadvantages of a Medical Gap Cover

While medical gap cover can offer many benefits, it is important to also consider the potential disadvantages. Here are some potential drawbacks to keep in mind:

  1. Cost: Medical gap cover can be an additional expense on top of your existing medical aid premiums. Depending on the plan you choose and the level of coverage you need, the cost of this additional insurance can vary significantly.

  2. Limited coverage: Gap cover is designed to cover specific expenses that are not fully covered by your medical aid plan, such as co-payments or deductibles. However, it may not cover all of the medical expenses you incur, so it is important to read the fine print and understand what is and is not covered.

  3. Waiting periods: Some gap cover plans may have waiting periods before coverage kicks in, meaning you may have to wait a certain amount of time before you can make a claim.

  4. Exclusions: Certain medical conditions or treatments may be excluded from gap cover, so it is important to understand any exclusions that may apply to your plan.

  5. Complexity: The world of medical aid and gap cover can be complex and confusing, with many different plans and options to choose from. This can make it challenging to select the right plan for your needs and understand the details of your coverage.

Overall, while medical gap cover can provide valuable additional coverage for medical expenses, it is important to carefully weigh the potential benefits and drawbacks before making a decision.

How to Choose the Best Medical Gap Cover Company for You

Choosing the right medical gap cover company is an important decision that can impact your healthcare coverage and financial well-being. Here are some tips to help you select the best medical gap cover company for your needs:

  1. Assess your needs: Before you start comparing medical gap cover companies, take the time to assess your needs and budget. Consider factors such as your existing medical aid plan, your health history, and any specific medical expenses you anticipate in the coming months or years.

  2. Research options: Once you have a clear understanding of your needs, it’s time to start researching medical gap cover options. Look for companies that offer plans that align with your needs and budget. Be sure to read the fine print carefully to understand what is and is not covered.

  3. Compare prices: Medical gap cover plans can vary significantly in cost, so it’s important to compare medical gap cover quotes from multiple providers. Consider the monthly premium as well as any additional costs such as co-payments or deductibles.

  4. Check reviews: Read online reviews and ask for recommendations from friends and family members to get a sense of the reputation of the medical gap cover companies you are considering. Look for companies with positive reviews and a history of reliable customer service.

  5. Consider the company’s track record: It’s important to choose a medical gap cover company with a strong track record of stability and financial strength. Look for companies that have been in business for a significant amount of time and have a solid reputation in the industry.

  6. Understand the claims process: Finally, it’s important to understand the claims process for the medical gap cover company you choose. Look for a company with a simple and transparent claims process, and consider factors such as how quickly claims are processed and how easy it is to submit a claim.

By following these tips, you can select a medical gap cover company that provides the coverage and peace of mind you need to stay healthy and financially secure.

Play Video about WHAT IS MEDICAL GAP COVER AND HOW DOES IT WORK

Conclusion

Medical gap cover can be a valuable addition to your healthcare coverage, providing peace of mind and financial protection in the event of unexpected medical expenses. When choosing a plan, be sure to carefully consider your own healthcare needs and budget, and compare different options from reputable providers.

Frequently Asked Quetions (FAQ)

Medical gap cover is not a substitute for medical aid. Most medical gap cover providers in South Africa require you to have an existing medical aid plan to be eligible for their gap cover product. It’s always best to check with the specific provider for their eligibility requirements.

The cost of medical gap cover varies depending on the provider and the level of cover you require. Generally, you can expect to pay a monthly premium ranging from a few hundred rand to over a thousand rand per month. It’s important to compare quotes from different providers to find a gap cover that suits your budget and needs.

Medical gap cover providers in South Africa typically do not cover pre-existing medical conditions. It’s important to read the terms and conditions of your gap cover policy carefully to understand what is and isn’t covered.

If you require medical treatment and your medical aid plan only covers a portion of the costs, you can submit a claim to your gap cover provider for the remaining balance. The specific process for making a claim varies depending on the provider, but generally, you will need to submit an itemised medical bill along with your claim form.

Whether or not medical gap cover is worth it for you depends on your personal circumstances and needs. If you have a comprehensive medical aid plan and are concerned about potential medical costs not covered by your plan, medical gap cover can provide peace of mind. However, if you rarely require medical treatment or have a limited budget, it may not be necessary. It’s always best to compare quotes and consider your personal situation before making a decision.

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