You have chosen your medical aid, and the specific plan you belong to – and you should understand the implications of your choice. Inevitably you need to make decisions based on your economic means, but this could still leave you with large copayments to settle medical bills.

Gap cover is a short-term insurance product available to all members of medical aids. There are over two hundred gap cover products available, and some medical aids, like Discovery, now offer their own gap cover. This insurance provides extra cover for medical shortfalls. There are criteria to be met, before gap will cover shortfalls, and you will have to determine what these are, and whether they make sense to you.

Medical aid membership does not guarantee payment for medical treatment – there are limitations, and certain criteria that must be met. Even if your medical aid authorizes treatment, it does not mean that they will pay for it, or pay the full amount charged by the medical practitioners involved – therefore you need to determine facts before committing to treatment.

The same applies for gap cover. Each gap cover policy has its own rules, and you cannot expect your medical practitioner to know what these are. It is important that you determine this prior to your medical treatment.

Some things you need to be clear about:

  • Must the procedure be performed in main theatre – many gap cover insurance products do not cover a procedure performed in doctors’ rooms.
  • What are the excluded benefits – some gap covers only cover so-called PMB conditions – conditions which meet certain criteria – in the case of plastic surgeons – cases of confirmed cancer, but not suspected cancer, and traumatic injuries.
  • Are there financial limitations in a specific year – if there are, it would be wiser to pick up the cost of minor expenses yourself, and only claim for big expenses.

Gap cover insurance is typically not very expensive (a couple of hundred rands per month), but offers huge financial peace of mind, should you need it – which is normally in the case of unexpected medical expenses, like traumatic injuries or cancer diagnoses.

Please investigate this as an option to assist you in financing the shortfall of medical treatments.