The Wealth Room

Gap Cover a non-negotiable today

The event of experiencing gaps between what doctors charge and what medical aids pay is becoming more and more of a reality for us in todays times. I am sure that you, or at least somebody close to you, has been victim to this “GAP”  and we know now that some doctors can charge up to 600% (or 6x) of medical aid rates. The last thing most of us can afford is to get caught off guard with a bill that is thousands of rands and possibly more than what your medical aid is prepared to pay.

BUT DON’T WORRY THERE IS A SOLUTION TO THIS PROBLEM IF YOUR MEDICAL AID ONLY COVERS YOU AT MEDICAL AID RATES!

So let’s talk about the solution to this problem (no matter what medical aid you belong to)! The solution to the problem is called Gap Cover and it does exactly what the name of the product implies. It Covers the Gap between what the doctor is charging over and above what medical aid rates cover.

The first thing that I would like to bring to your attention is that Gap Cover only really comes into play when you go for a planned (elective operation) procedure. In the event of an emergency you should be fully covered by your medical aid, as medical aids have to cover emergencies in full. However in the event of a planned procedure you will get three bills. The first bill will be as much as 60%-70% of the bill and this bill is related to all of the costs that you incurred during your stay in hospital. These bills can range from ICU, theatre, bed, food etc… in most cases what you would find is that the hospitals are charging medical aid rates, so this bill would be covered in full, so we don’t have to worry about this account.

However, the other two bills are derived from the Anesthetist (10%-15%) and Specialist (20%-25%) who will be preforming the procedure. These two bills are a little more tricky, as each specialist is entitled to charge as they please and the better they are, the more they are going to charge.

So my little piece of advice, if you don’t have Gap Cover in place is to do your homework and find out what rates they will be charging before you have any operation. Alternatively, if you want peace of mind (for such a small price) and would like to go to the best specialists in their field, then Gap Cover is a brilliant option for you.

If you would like more information on this get in touch with your CERTIFIED FINANCIAL PLANNER® asap!

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