Gap Cover , best company out there?

[3Gee]

Which company offers the best Gap Cover based on experience / claims history?

Im currently with Sirago , looking at changing as they have way too many limits imposed

 

[SpoonTech]

Which company offers the best Gap Cover based on experience / claims history?

Im currently with Sirago , looking at changing as they have way too many limits imposed

I use CompliMed / Ambledown and they have good offerings.

 

[Drone 42]

I use Xelus

 

[FuLL_MeT4L]

I also use Ambledown. Claimed for an op earlier this year, no problems at all.

 

[GhostSixFour]

Zestlife - two claims so far - two successes.

 

[Superjakes]

My employer signed us up with Xelus. Had one claim so far, took a bit long to process, but got paid out with no hassles.

 

[theratman]

Been trying to get complimed to contact me to get cover, have to go through a broker and none of them are getting back to me. Will have a look at Ambledown and see if they are arsed.

 

[Foxhound5366]

So I've got only a vague idea of how this works ... can somebody please explain how frequently gap cover is necessary?

I'm with Discovery and I just figured there shouldn't be any 'gap' to cover. Have people specifically had need of gap cover with Discovery?

 

[Superjakes]

So I've got only a vague idea of how this works ... can somebody please explain how frequently gap cover is necessary?

I'm with Discovery and I just figured there shouldn't be any 'gap' to cover. Have people specifically had need of gap cover with Discovery?

My example is as follows: Discovery feels that a gastroscopy is something that a doctor can do in his rooms, and it is not necessary to do it in a hospital. My wife had it done in a day hospital, therefore there is a co-payment to be made by the member. The entire claim was processed from the in-hospital portion of the plan instead of the savings. Anyways, I claimed for the co-payment which was about 3k and they covered it.

 

[Scooby_Doo]

I am with Old Mutual at R130 pm, 400% cover. At least i think its 400%

 

[Foxhound5366]

My example is as follows: Discovery feels that a gastroscopy is something that a doctor can do in his rooms, and it is not necessary to do it in a hospital. My wife had it done in a day hospital, therefore there is a co-payment to be made by the member. The entire claim was processed from the in-hospital portion of the plan instead of the savings. Anyways, I claimed for the co-payment which was about 3k and they covered it.

Thanks for that, but two questions though:
1: Isn't this why Discovery insists that you clear any hospital work with them before it's done, in order to avoid any unplanned copayments being necessary?
2: How much do you pay for your gap cover? (so that I can weigh the relative benefit of R3 000 liability being covered)

I'd be really interested to hear what the largest copayment anybody has been faced with that was covered by their gap cover, when their medical aid rejected it. So far we've got R3 000, any higher? What were the circumstances?

 

[biometrics]

Don't know who is the best but I signed up with these recently: http://gap-protect.co.za/

 

[ScottulusMaximus]

Gf works at a Netcare dealing with exactly this sort of stuff, routinely processes 80-100k co-payments... And Discovery is shyte unless you're on the top tier apparently

 

[Foxhound5366]

Gf works at a Netcare dealing with exactly this sort of stuff, routinely processes 80-100k co-payments... And Discovery is shyte unless you're on the top tier apparently

I (maybe naively) have believed that Discovery strikes deals with certain hospitals and doctors 'in their network', to afford their clients care without copayments. Isn't it only when you 'push the boundaries' - e.g. have cases which aren't typically covered by medical insurance, claim very regularly, or go to a special hospital or doctor without first obtaining Discovery's authorization, that you pick up the biggest copayments?

 

[ScottulusMaximus]

I (maybe naively) have believed that Discovery strikes deals with certain hospitals and doctors 'in their network', to afford their clients care without copayments. Isn't it only when you 'push the boundaries' - e.g. have cases which aren't typically covered by medical insurance, claim very regularly, or go to a special hospital or doctor without first obtaining Discovery's authorization, that you pick up the biggest copayments?

Nope they have limits they're willing to pay for any procedure, just as an example their back/neck surgery limit is 50k(for whatever specific package), last week an elderly man needed 2 new prosthetic disks that were 100 and something k, had to pay the shortfall

 

[Foxhound5366]

Nope they have limits they're willing to pay for any procedure, just as an example their back/neck surgery limit is 50k(for whatever specific package), last week an elderly man needed 2 new prosthetic disks that were 100 and something k, had to pay the shortfall

You know, I don't see the gap cover providers being run like a charity, so where is their catch? I doubt that they're going to sign a blank cheque effectively, promising to cover whatever gap - no matter how high it might be - exists, so wouldn't it be better (and even cheaper) sometimes to pay for a more expensive medical aid (with higher limits), rather than a cheaper one and a separate gap cover (with its own limits)?

They're honest questions, I've got no clue. So far I've just been going on faith as a young and relatively healthy guy, but I'm going to have to start reading the fine print more closely.

 

[ScottulusMaximus]

You know, I don't see the gap cover providers being run like a charity, so where is their catch? I doubt that they're going to sign a blank cheque effectively, promising to cover whatever gap - no matter how high it might be - exists, so wouldn't it be better (and even cheaper) sometimes to pay for a more expensive medical aid (with higher limits), rather than a cheaper one and a separate gap cover (with its own limits)?

They're honest questions, I've got no clue. So far I've just been going on faith as a young and relatively healthy guy, but I'm going to have to start reading the fine print more closely.

Oh I'm sure there is a catch... But I can't answer those questions I'm afraid.

 

[biometrics]

You know, I don't see the gap cover providers being run like a charity, so where is their catch? I doubt that they're going to sign a blank cheque effectively, promising to cover whatever gap - no matter how high it might be - exists, so wouldn't it be better (and even cheaper) sometimes to pay for a more expensive medical aid (with higher limits), rather than a cheaper one and a separate gap cover (with its own limits)?

They're honest questions, I've got no clue. So far I've just been going on faith as a young and relatively healthy guy, but I'm going to have to start reading the fine print more closely.

Gap cover also has limits.

Keep in mind you can only use the gap cover after using your hospital plan cover and it's only for in-hospital. So it's not like you can abuse it, it's usually something serious.

Quote from my providers website:

Did you know…

100% Medical aid cover MAY NOT COVER 100% of your doctors’ bills.

100% Cover is the ABSOLUTE MINIMUM that a doctor would charge, not the maximum.

What is Gap Cover?

Gap cover fills the gap between what is covered by your Medical Aid, and the actual amount charged by your medical practitioner for in-hospital procedures.

Since 2009 almost every doctor in every SA private practice charges MORE than 100% for almost every procedure, therefore you will probably receive an extra bill every time you are hospitalised if you only have 100% medical aid cover.

This is the one I took: http://gap-protect.co.za/wp-content/uploads/2015/03/male-exec-single-plus-brochure.pdf

 

[lexor]

I'm using Sirago .

Never claimed so cannot comment on that.

 

[jerome000]

Gap cover will see some changes soon.
Would be nice to see in any gap company, the actual number of claims paid over R30k for example.