The Wealth Room

Gap Cover has become a non-negotiable

Increasingly we are experiencing gaps between what doctors charge and what medical aids are prepared to pay, with some doctors charging up to 600% (or 6x) the medical aid rates. The last thing you need is to get caught off guard with a bill your medical aid is not prepared to pay in full.

Fortunately Gap Cover offers a solution to this problem, regardless of the medical aid you belong to. The product does exactly what the name implies: it covers the gap between the doctor’s fees and medical aid rates.

Gap Cover only comes into play when you go for a planned procedure (elective operation). In an emergency, you should be fully covered by your medical aid.

After a planned procedure, you will receive three bills. The first bill will be approximately 60%-70% of the total amount and will cover the costs you incurred during your hospital stay, for example the ICU, theatre and food. Most hospitals charge medical aid rates, so this account will be covered in full.

The last two bills will come from the anaesthetist (10%-15%) and the specialist (20%-25%) who performed the procedure. These two bills are more tricky since specialists are entitled to charge as they please. The better they are, the more expensive they will be.

If you don’t have Gap Cover, make sure you do your homework and find out what rates you will be charged before you select your specialist. Alternatively, if you want peace of mind (for a small price) and would like to go to the best specialists in their field, then Gap Cover is a brilliant option for you.

For more information on Gap Cover, get in touch with one of our Certified Financial Planner®.