Gap Cover

gotaway

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Jun 15, 2010
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So, staying in the sticks and not having needed any majorly expensive surgery (discounting a plated clavicle and wrist - both 'high' speed bicycle accidents) I was blissfully ignoring the whole gap cover thing.

Come the past year, hip pain, lack op power cycling, and running simply just hurting. Sitting still only works for 20 minutes. Been taking more pain meds that vitamins (not really, but a lot for me yes)
Landed up at a ortho specialist in Potch, only to refer myself to one in Jozi area. A common question from the few practices I contacted was what (not if) gap cover I have.

Luckily the doc I picked is contracted by my employer imposed medical aid, so he'll be paid by them.
I received a quote for the prostheses he plans to use. The worst case for them came to R84k. (basically 6 screws and 6 sutures). The medical aid is covering just shy of R30k. There is an outside chance of a possible 50% discount on the prostheses quote, waiting for either a discount line to be added, or the totals to be adjusted upwards.

Obviously too late to get gap cover for this, although I've signed up for Stratum's Elite 500 option (recommended by broker). I will have to wait a year for hip op cover, and then they only add another R40k on top of what my medical aid covers for these (I might have a similar, but less broken scenario on the other hip)

Question: Is gap cover actually 'normal' these days, or have I been staying under the proverbial rock?
 
It's normal.. have had to use it on a number of occasions now..
Agreed, I will never risk going without it. Just think of the shitshow you can end up in an emergency situation and the medical bills start rolling in afterwards from non-contracted doctors & specialists who treated u.
 
Gap cover saved us about 40k when we had our child it even covered the private room.
 
Off topic but might be ideal to wait a while and save up on leave days. Pain for hip and knee ops is usually very very painful and you’ll be home for a lot longer than what the doctors say it should take.
 
Off topic but might be ideal to wait a while and save up on leave days. Pain for hip and knee ops is usually very very painful and you’ll be home for a lot longer than what the doctors say it should take.

I’m to be booked off for 6 weeks. Been having issue for a few years now.

It will take about 224 hours of sick leave. I have 205+174 hours available
 
Hopefully (I doubt these things “go alone”) I’ll have enough leave available again when (worst case) the other one needs “augmentation”. But then waiting periods on gap cover should be over as well
 
Agreed, I will never risk going without it. Just think of the shitshow you can end up in an emergency situation and the medical bills start rolling in afterwards from non-contracted doctors & specialists who treated u.

The doctors are still manageable, kinda. But the new parts they want to use seem (from an experience of 1 event) prohibitively expensive
 
Back to the topic. From looking at 2 companies, it seems that the upper limit for gap cover is just shy of R200k a year. Various sub-limits and a few other things come to play as well.

Are gap cover policies regulated as to what they may offer?
 
Back to the topic. From looking at 2 companies, it seems that the upper limit for gap cover is just shy of R200k a year. Various sub-limits and a few other things come to play as well.

Are gap cover policies regulated as to what they may offer?
I think the ulitmate cap from any is 200k
 
Looking at some of then options (non-medical aid administrator based), two names seem to pop up all the time: Guardrisk and Bryte.

Terms of the various options seem all to have something along the lines of “balance of waiting periods will be ‘enforced’ on changing to another gap cover scheme”. That, along with very similair benefits between companies (agents?), seem to suggest that there is a limited group of actual underwriter products behind the front end options.

Anybody willing to confirm / refute this?
 
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