Do you have a Gap Cover policy?

Do you have a Gap Cover policy?

  • Yes

    Votes: 121 50.2%

  • No

    Votes: 114 47.3%

  • Other

    Votes: 6 2.5%
  • Total voters
    241
Were about two months into Covid lock down when my wife was diagnosed with breast cancer. A few lessons learned.

1) GAP cover is crucial. It takes time to get the patient approved and onto the oncology benefits with discovery. Yes it took paperwork but I was fully reimbursed for all that discovery did not cover or fell short on. My GAP cover is not with discovery. I am talking within a short while I had to fork out about R80k. Only one chemo session is between 7k and 15k
2) Dreaded disease cover. This is a life saver. When you are fighting to stay alive you do not need the worries of there is no money to do this or that.

I remember my wife telling me heartbreaking stories of people she met in the chemo sessions that had to stop treatment because of no funds.

I will never go without medical aid, gap cover or dreaded disease cover. I truly believe that I would have lost my wife and probably my home trying to cover the costs of everything.

Glory to God my wife is alive and well today.
 
Last edited:
saturnz said:
false equivalence, not everyone is looking, and I am still going about my life whereas a car accident is a disruption, also those that are fascinated by the accident don't go to the victims or person responsible for the accident and ask them question after question

also try to use the appeal to a majority more carefully next time
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You are absolutely free to do what you want, good on you for doing it. Nevertheless, everyone here commenting on your decision is because they can see the disaster coming.
 
konfab said:
You are absolutely free to do what you want, good on you for doing it. Nevertheless, everyone here commenting on your decision is because they can see the disaster coming.
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they are merely speculating and engaging in conjecture, when asked to provide probabilities to said events they were unable to do so

and you would fail at doing so as well
 
Kosmik said:
Gap is not medical aids fyi, only recently have they got involved. Its short term insurance.
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I do have to ask what is recent? I had Admed and was with them like since I was in my early twenties. That is a long time ago.
 
saturnz said:
they are merely speculating and engaging in conjecture, when asked to provide probabilities to said events they were unable to do so

and you would fail at doing so as well
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The entire insurance industry business model is designed around the fact that most people are not good at estimating their risk, so they pay a company to manage it for them. Doing this for hospital cover and chronic disease cover is quite tricky.

I am shaking up my healhtcare a bit, which is ditching the hospital plan+savings option and moving over to managing the savings myself. But I am probably going to still latch onto Discovery's estimate for MSA contributions. Only difference I am getting double the amount out for spending the same amount of money.
 
Fulcrum29 said:
I do have to ask what is recent? I had Admed and was with them like since I was in my early twenties. That is a long time ago.
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The main medical aids offering gap cover as well ie: Discovery etc. It was offered mainly by third party insurers before : Complimed, Turnberry etc.

Say post 2017.

From what I google Admed is the same boat, its a gap cover insurance company NOT a medical scheme/aid.

Looks like Guardrisk is the insurer.
 
My 2c , when gap was unlimited or capped at 2M etc, most insurance companies were happy to take the risk book for the low cost premium and quantity. The medical aid schemes only jumped on the band wagon when the risk was suddenly capped at R150k ( and inflationary since then ).
 
konfab said:
The entire insurance industry business model is designed around the fact that most people are not good at estimating their risk, so they pay a company to manage it for them. Doing this for hospital cover and chronic disease cover is quite tricky.
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supporting my point

konfab said:
I am shaking up my healhtcare a bit, which is ditching the hospital plan+savings option and moving over to managing the savings myself. But I am probably going to still latch onto Discovery's estimate for MSA contributions. Only difference I am getting double the amount out for spending the same amount of money.
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cool story
 
engelbma said:
Were about two months into Covid lock down when my wife was diagnosed with breast cancer. A few lessons learned.

1) GAP cover is crucial. It takes time to get the patient approved and onto the ecology benefits with discovery. Yes it took paperwork but I was fully reimbursed for all that discovery did not cover or fell short on. My GAP cover is not with discovery. I am talking within a short while I had to fork out about R80k. Only one chemo session is between 7k and 15k
2) Dreaded disease cover. This is a life saver. When you are fighting to stay alive you do not need the worries of there is no money to do this or that.

I remember my wife telling me heartbreaking stories of people she met in the chemo sessions that had to stop treatment because of no funds.

I will never go without medical aid, gap cover or dreaded disease cover. I truly believe that I would have lost my wife and probably my home trying to cover the costs of everything.

Glory to God my wife is alive and well today.
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Glad there was a happy conclusion, I’d hate to try fight that battle without private health care.
Which gap cover did you have?
 
hospital plan + gap cover works very well for us. we don't make incidental visits to the doctor very often. all major medical expenses are typically hospital admissions. meds can hurt a little financially, but not nearly as much as upgrading our primary medical cover. i have various meds on PMBs and my son's meds are also a PMB.

gap cover covers the difference between in-hospital doctors' rates vs medical aid rates.
 
On the parent's medical aid. We did have gap cover up until sometime in 2017 when my right lung collapsed. I was lying in a hospital bed listening to my parents talk to the doctor and he asked them if they had gap cover. Ballie cancelled the gap cover after shortly my surgery because it seemed more like the doctor was just thumb sucking a price to make more money out of us rather than actually using the gap cover as a shortfall for the real cost of the surgery.
 
Nope, why? I should be cancelling even my medical aid as the great NHI will be here soon, so I can join the 28million breeding 30%ers with their babies on grants in the queue.
 
First time in hospital in December 2023 at age 58. Had medical aid all my life and thought little of gap cover. Do have it, but thought that medical aid was the main payment mechanism to cover costs with gap covering that small unpaid amount. WRONG! Gap cover is the main portion of payment in my case. Discovery Coastal core payed less that 40% of the bill costs. I was shocked at this. So, those 48% not having gap ... you better rethink.
 
TimBru14 said:
On the parent's medical aid. We did have gap cover up until sometime in 2017 when my right lung collapsed. I was lying in a hospital bed listening to my parents talk to the doctor and he asked them if they had gap cover. Ballie cancelled the gap cover after shortly my surgery because it seemed more like the doctor was just thumb sucking a price to make more money out of us rather than actually using the gap cover as a shortfall for the real cost of the surgery.
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There‘s no need or obligation to tell any service provider you have gap cover.
 
I do have gap cover and it has been worth it: after four surgeries in 2 years, the gap cover paid the excess and saved me from a lot of financial stress. I consider myself to be in good health, but life happens!
 
MrDIY said:
First time in hospital in December 2023 at age 58. Had medical aid all my life and thought little of gap cover. Do have it, but thought that medical aid was the main payment mechanism to cover costs with gap covering that small unpaid amount. WRONG! Gap cover is the main portion of payment in my case. Discovery Coastal core payed less that 40% of the bill costs. I was shocked at this. So, those 48% not having gap ... you better rethink.
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Where did extra cost come from, service providers charging way over medical aid rates?
How easy was it claiming from your Gap cover?
One complaint I have heard more often than I’d like to about gap cover policies is they do pay out but take forever to do so and in the meantime the client has to take the full gap shortfall on the chin right when they can least afford it.
 
Johnit said:
I do have gap cover and it has been worth it: after four surgeries in 2 years, the gap cover paid the excess and saved me from a lot of financial stress. I consider myself to be in good health, but life happens!
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What kind of amounts did they cover?
 
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