Old Mutual Medical Gap Cover Review

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Old Mutual Medical Gap Cover at a Glance

Old Mutual Medical Gap Cover at a Glance

  • 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 we like:

Old Mutual Medical Gap Cover offers an extra financial cushion for South Africans with existing medical aid schemes. The premiums are very competitive, and quotes are based on all the dependents listed on your medical aid which makes the finer details of your policy easier to keep track of.

Best for:

This policy is best suited to people who have an existing medical aid scheme but want reassurance that they will not have to make excessive out-of-pocket payments for medical treatments. Old Mutual’s Medical Gap Cover can give peace of mind to consumers who anticipate making frequent medical aid claims, for example, people with chronic illnesses or a family history of cancer or organ failure.   

  • Covers most treatments and procedures already listed by your medical aid scheme.
  • Competitive premiums based on your entire family.
  • Shortfalls covered up to 500% of designated service providers.
  • No opportunities to earn cash back on premiums.
Table of Content

Sometimes accidents happen, and you have a few bumps and scrapes that Dettol and a Band-Aid can’t fix! Medical aid is a great way to financially cushion medical-related expenses, whether it’s just over-the-counter medicine for a cold or an extended hospital stay. But what happens when your medical aid doesn’t cover all your expenses?

Old Mutual Medical Gap Cover is designed to financially assist South Africans when their medical aid does not fully cover a bill. Their Medical Gap Cover has four core benefits, with a total of R169,000 paid out per family member per annum. Coverage ranges from hospitalisation to cancer treatments to emergency medical services. Let’s discuss the core benefits, unique features, and pricing of Old Mutual’s Medical Gap Cover policies!

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What Makes Old Mutual Medical Gap Cover Different?

Old Mutual has been around for 177 years and offers many other financial products; this makes it easier for its large existing customer base to find a trusted insurer. Starting from R225 per family and R295 for families with members over the age of 65, you get more bang for your buck with Old Mutual! In comparison, Sanlam’s Comprehensive Gap Cover Plan starts from R246 per month for individuals and R429 per month for families.

Old Mutual Medical Gap Cover Coverage Options and Benefits

Important terms to note when comparing medical aids and medical gap cover is the ‘medical aid scheme tariff’ or the National Health Reference Price List (NHRPL) tariffs. The NHRPL tariffs are decided by the South African Department of Health. These refer to guideline prices for medical treatments, however, hospitals and healthcare practitioners often charge much more.

Ideally, if your hospital or health care provider charges more than your medical aid scheme tariff, your gap cover should compensate accordingly. For example, if your doctor charges 300% of the NHRPL rate and your medical aid only covers 100% of the rate, your medical gap cover should cover the remaining amount.

In-hospital Benefits

If you are hospitalised, Old Mutual will provide financial compensation for up to 500% of your medical aid’s tariff fee on shortfalls. However, for maxillofacial, back surgery, and in instances where you used a non-designated service provider, Old Mutual will only pay up to 100% of your existing tariff fee on shortfalls.

While the general rule is that Old Mutual’s Medical Gap Cover will cover expenses covered by your medical aid, there are a few limits when it comes to certain diagnostic and medical procedures. There is also an R50,000 claim limit per event and an R5,000 claim limit on dental surgery shortfalls.

Out-of-hospital Benefits

The out-of-hospital benefits for Old Mutual’s Medical Gap Cover are very similar to their in-hospital benefits. Out-patient procedures are covered for up to 500% of your medical aid scheme tariff, and using a non-designated service provider also means maximum compensation of 100% of your scheme tariff.

There are limits depending on the type of treatment, particularly diagnostic procedures. However, this also covers casualty ward expenses up to R15,000 per year, and a maximum of R2,000 for appliances such as knee braces, crutches, and arm slings.

Benefit Extender

The ‘Benefit Extender’ comes with a family booster benefit for premature birth, and an increased dental reconstruction benefit with a claim limit of R40,000 per year. Additionally, you can claim cash back if you pass away or are permanently disabled. The maximum amount you can claim is equivalent to 6 months of medical scheme contributions or R30,000.

Pricing and Discounts of Old Mutual Medical Gap Cover

Old Mutual Medical Gap Cover starts from R225 per month per family but is subject to a number of factors. The policies offered by Old Mutual take into account your immediate family members, which includes your partner, children up to the age of 26, and any other dependents listed on your existing medical aid scheme.

Your premiums may be influenced by the ages and existing health conditions of your family. Unfortunately, there are currently no discounts or opportunities to earn cash back on this Old Mutual product.

Where Old Mutual Medical Gap Cover Can Improve

It can be confusing determining which procedures and treatments are covered by Old Mutual Gap Cover, as there are several exceptions and sub-limits to take note of in your policy. Old Mutual could make information regarding their coverage and limits easier to find, so consumers can make informed decisions. While the premiums are competitive, there are no opportunities to earn cash back or other incentives for remaining claim-free.

How to Request a Quote for Old Mutual Medical Gap Cover

  • Provide your name and contact number on the Old Mutual website for a callback
  • Phone 0860 111 023 to speak to a consultant

It may be helpful to have personal information regarding the members of your medical aid on hand, for example, their ages and general medical history. You should also be able to provide information about your medical aid scheme.

Frequently Asked Questions (FAQ)

No, gap cover is designed to be used in conjunction with your existing medical aid scheme to cover shortfall payments.

Yes, there is a three-month general waiting period. There is a waiting period of one year for claims on pre-existing conditions.

No, prescribed minimum benefits are not covered by Old Mutual’s Medical Gap Cover.

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