Poll: is medical gap cover worthwhile?

[Foxhound5366]

Ever since I heard that medical gap cover had its maximum payout capped (a few years ago) I just lost interest in the product.

I also find it terrible that Discovery will happily sell you gap cover to protect you from shortfalls in their own medical aids.

Taking insurance on my insurance … I can’t bring myself to pull the trigger on it. Any good or bad experiences you can share with it?

 

[lexor]

Have my Sanlam gap cover for about 5 years now.
Pay about R350p/m - family plan
Claimed( no hassles) about R 45 000 during this period.
Works for me.

 

[Pegging]

Ever since I heard that medical gap cover had its maximum payout capped (a few years ago) I just lost interest in the product.

I also find it terrible that Discovery will happily sell you gap cover to protect you from shortfalls in their own medical aids.

Taking insurance on my insurance … I can’t bring myself to pull the trigger on it. Any good or bad experiences you can share with it?

We use discovery gap cover and it’s been worthwhile. They covered everything for the others half’s ops.

I think you need to read up on how medical aids work.

 

[Tomtomtom]

I also find it terrible that Discovery will happily sell you gap cover to protect you from shortfalls in their own medical aids.

^ This. It may be entirely legitimate but it sure does smell.

Tell the specialist you don't have gap cover and you might be surprised to find they're prepared to discount your shortfall by 50%. Let's just say it's pretty clear they're not pricing their services close to marginal cost. Instead their invoice is more like an opening bid aimed directly at your insurance. Perfectly rational, from the doctor's perspective.

Also worth noting not all doctors will test this, at 300%+ medical aid rates. We recently had a good experience of no shortfall on a basic hospital plan.

 

[Foxhound5366]

I think you need to read up on how medical aids work.

How they work? Your insurer bets you won't get sick and agrees to accept the risk if you do. You bet you will get sick and pay a premium to your insurer for the peace of mind. Do you have some "magical guide to medical insurance" the rest of us mere mortals didn't get access to?

 

[Pegging]

How they work? Your insurer bets you won't get sick and agrees to accept the risk if you do. You bet you will get sick and pay a premium to your insurer for the peace of mind. Do you have some "magical guide to medical insurance" the rest of us mere mortals didn't get access to?

What is your issue with this “to protect you from shortfalls in their own medical aids.”?

 

[3WA]

Add option to poll: I have it and have never used it but not about to cancel because I understand that I may need it one day.

 

[Foxhound5366]

Add option to poll: I have it and have never used it but not about to cancel because I understand that I may need it one day.

Done, just for you

 

[3WA]

Done, just for you

Not that I think I’ll need it one day. My belief is that no matter how unlikely an event is, you insure against it if it could possibly bankrupt you.

I’ll be very happy to live my whole life having never used my gap cover, but I’ll keep it since I don’t want to be bankrupted if I develop Hodgepikinson’s Nymphomania or something.

 

[Barbarian Conan]

Ever since I heard that medical gap cover had its maximum payout capped (a few years ago) I just lost interest in the product.

I also find it terrible that Discovery will happily sell you gap cover to protect you from shortfalls in their own medical aids.

Taking insurance on my insurance … I can’t bring myself to pull the trigger on it. Any good or bad experiences you can share with it?

I only have it because of my plan.

The Discovery Classic Smart Plan only covers 100% medical aid rates, whereas specialists easily charge 200-300%. Gap cover bumps it up to 500%.
The Smart Plan requires a co-payment of R8800 (probably R10K by now) if you have your procedure done at a non-network hospital. Gap cover covers that co-payment once a year.

The last time I checks, I have claimed more from gap cover than I paid. I think I may have evened out by now.

If I was on one of the classic comprehensive plans that gave me access to all hospitals and covered me for 200-300% medical aid rates, I wouldn't have taken gap cover.

 

[SauRoNZA]

It’s paid for itself every year I’ve had it.

But yes it grates my tits that it’s even necessary and sold by the very same people because their product doesn’t do the job in the first place.

I’m of the opinion take as low a medical aid plan as you can and the gap cover with the most benefits.

Highly recommend Stratum. I’d never get it from the same place as my medical aid out of the simple principle of the matter.

 

[FiestaST]

I have none, just a simple Disco Hospital Plan that is fine for my needs.
I am of the view that if you're (relatively) healthy a good povo spec hospital plan is all you need.

 

[Foxhound5366]

It’s paid for itself every year I’ve had it.

But yes it grates my tits that it’s even necessary and sold by the very same people because their product doesn’t do the job in the first place.

I’m of the opinion take as low a medical aid plan as you can and the gap cover with the most benefits.

Highly recommend Stratum. I’d never get it from the same place as my medical aid out of the simple principle of the matter.

Stratum looks interesting, but this benefit is just about worthless. What do they want you to do with this?

“ACCIDENTAL DISABILITY AND DEATH
You and your spouse are covered for a benefit amount of R 5 000 per person if either one of you becomes totally and permanently disabled, or passes away due to an accident.
Limited to 1 event per person per year.”

I promise I won’t die more than once in a year.

 

[Grubscrew]

Our Discovery plan pays upto 200%, never had an issue.

 

[bwana]

Made use of it recently when my kid needed their wisdom teeth removed. It's one of those things that I pay for just in case, like medical aid, security company, car insurance, heck - any insurance because that's what it's for.

Hope I don't need it, glad it's there when I do.

Hope for the best, plan for the worst
~Jack Reacher​

Tell the specialist you don't have gap cover and you might be surprised to find they're prepared to discount your shortfall by 50%.

And they might not. What then?

 

[SauRoNZA]

Stratum looks interesting, but this benefit is just about worthless. What do they want you to do with this?

“ACCIDENTAL DISABILITY AND DEATH
You and your spouse are covered for a benefit amount of R 5 000 per person if either one of you becomes totally and permanently disabled, or passes away due to an accident.
Limited to 1 event per person per year.”

I promise I won’t die more than once in a year.

I think it’s just one of these bolt-ons you see with so many other small products.

You’ll be amazed how much money that accumulates to between this cellphone contract and that random retail account etc.

 

[SauRoNZA]

Our Discovery plan pays upto 200%, never had an issue.

Yeah good luck with that when you run into a 500% specialist and you aren’t in a position to choose them up front.

 

[Katelknaap]

^ This. It may be entirely legitimate but it sure does smell.

Tell the specialist you don't have gap cover and you might be surprised to find they're prepared to discount your shortfall by 50%. Let's just say it's pretty clear they're not pricing their services close to marginal cost. Instead their invoice is more like an opening bid aimed directly at your insurance. Perfectly rational, from the doctor's perspective.

Also worth noting not all doctors will test this, at 300%+ medical aid rates. We recently had a good experience of no shortfall on a basic hospital plan.

Sound advice for planned procedures.
Wife had to have an op on her shoulder, got quoted over R 50k. Gap cover, what's that, me no have, quote down to R 12k.

As most of these plans also have an overall yearly limit, you don't want to use it early in the yearly and be caught out later in the year if there's not enough left over.

Another essential grudge purchase for me, can't risk being without it in our country and it has saved me plenty.

 

[Superjakes]

OK, so my situation is as follows. My company subsidises medical aid and Gap Cover is part of the package. I will note that Gap cover is not from Discovery (where the medical aid is from). Our Gap cover premium is R162 per month and yes, there is an annual limit. The annual limit is something like R185k per person per annum, and according to the presenter, this is regulated.

Practical use - co-payments in any hospital procedure. You will easily pay 3 - 4k per event when a "scope" is used. That is not the old timey girlie mag, but includes endoscopes, gastroscopies, colonoscopies, et cetera. Our little one had a kidney procedure earlier this year. Enter "scope" and co-payment. R160 x 12 = R1920 < R6150 (upfront co-payment amount).

Just one more thing - medical expenses are a tax deduction. Gap cover is insurance. So, strictly speaking, R6150 from my pocket is a tax deduction, not to be added back because I got my money back from insurance. Use it, don't use it - your choice.

 

[Thrasil]

I have none, just a simple Disco Hospital Plan that is fine for my needs.
I am of the view that if you're (relatively) healthy a good povo spec hospital plan is all you need.

seen far to many healthy people get taken out with no warning. Until you sitting with enough cash in the bank to weather these random events (aka cancer/auto immune etc) then my policy is you insure as high as you feasibly can. Gap cover lets me top up that level nicely and it has paid for itself considering the cost is fairly small.

Agree with a earlier comment. If they ask if you have gap cover. Dont confirm. As they are just taking the insurers to the cleaner. 90% of the times it feels like they drop the rate or offer a settlement discount.