MEDICAL AID GAP COVER

[ice_cubes]

Hi guys

So I have been searching around & discovered that not all the GAP cover products offer the same service. So now I am really lost!

1. What is the minimum that GAP cover should be paying for?
2. What other additional extras would be advisable to get on GAP cover?

 

[ElementZero]

I've got GAP cover from stratum benefits and claimed from them once didn't have any issues.

We are on discovery priority series which has co payments for certain in hospital procedures.
for example an endoscope will have a co payment of R2000 that you have to pay ,

once procedure is complete send the bill to Stratum and they cover it, no issues at all.

They will only cover hospital (i think they all only do that).

they cover upto 400% for in hospital specialist fees , which is really helpful as med aid only covers 200%.
It costs us R185 per month for a family.

 

[Other Pineapple Smurf]

Gap cover I'm looking at covers the 200%-500% rate (300% cover) and thats R120 pm for family of 4.

All I can say is don't make excuses and just get it. Already this month my daughter was hospitalised and we can expect to pay in (last year we would have saved ourselves R10K if we had Gap cover, thats 8 yrs premiums!!!)

 

[Other Pineapple Smurf]

From my broker. This Gap cover is underwritten by Resolution:

Here is some more information regarding Gap Cover.

R120 per month for a family of 5 that covers 2 adults and up to 3 kids.

Provides cover of up to 500% of the medical aid rates with a limit of R2.5mil per year.

EDIT: You don't need a medical aid / hospital plan to have Gap cover. So even if somebody does not have medical cover, they should at least have Gap cover.

 

[Faetsa]

Which medical aid are you on? There is a few companies which you could get a GAP cover from. Just to clear this up: all medical aids have different rates for example a GP visit could be rated at R220 on Discovery, R250 on Momentum, R300 on Liberty, these are not the actual rates but just an example, so now you go to the GP who charges say R350 which means that you would have to pay in the difference between your medical aid rates and your doctor's charge.

GAP cover works differently. It only covers you in hospital and again medical aid rates are different to all providers. Say you had to go for an op and medical aid rates for the anaethetist are R5000 but he/she says my rate is say R20 000 that's when the GAP cover pays out. GAP cover is affordable and everyone should have it. It also takes away the need for being on a more expensive medical aid option as with GAP you don't need to pay medical aid option that is 200% or 300% which automatically makes it more expensive anyway.

 

[ice_cubes]

Which medical aid are you on? There is a few companies which you could get a GAP cover from. Just to clear this up: all medical aids have different rates for example a GP visit could be rated at R220 on Discovery, R250 on Momentum, R300 on Liberty, these are not the actual rates but just an example, so now you go to the GP who charges say R350 which means that you would have to pay in the difference between your medical aid rates and your doctor's charge.

GAP cover works differently. It only covers you in hospital and again medical aid rates are different to all providers. Say you had to go for an op and medical aid rates for the anaethetist are R5000 but he/she says my rate is say R20 000 that's when the GAP cover pays out. GAP cover is affordable and everyone should have it. It also takes away the need for being on a more expensive medical aid option as with GAP you don't need to pay medical aid option that is 200% or 300% which automatically makes it more expensive anyway.

Ok, nicely summarized! thanx!
I'm using Medihelp Necesse

 

[ld13]

Sorry for the bump peeps.

I work with medical aids etc every day and I am sick of getting all the flack of people taking out their medical aid frustrations on me. I still get people that walk in and expect their GAP cover to pay for eg. out of hospital optical products or whatnot. That is just not how GAP cover works. It is designed mainly for in-hospital procedures et al. Or am I wrong here?

EDIT: You don't need a medical aid / hospital plan to have Gap cover. So even if somebody does not have medical cover, they should at least have Gap cover.

Since when? I thought the whole idea around medical aid gap cover is to provide you with that additional coverage when your medical aid scheme does not pay certain claims in full. I've yet to see one GAP cover policy that does not specifically state that you are only covered for stuff that your medical aid does not pay for or even cover to begin with. In other words, if you are not covered by a medical aid they will pay out R0.00.