Question about medical aid gap cover

Magandroid

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If someone has medical aid with, say, Discovery Medical Aid, and want to take out gap cover, must the gap cover be with Discovery or are there other institutions that also offer gap cover?
 

3WA

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Others also offer.

E.g. Turnberry, Sanlam.
 

3WA

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Zestlife, Momentum, Old Mutual, ABSA, etc. There are so many providers nowadays...

But which one is any good? I haven't ever claimed so I only know who's good at processing debit orders.
 

Magandroid

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But which one is any good? I haven't ever claimed so I only know who's good at processing debit orders.
Thanks everyone for the responses and this was going to be my next question.
 
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lexor

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I'm with Discovery for medical aid but found their GAP cover a bit expensive.

My GAP cover is with Sanlam and so far so good ( I claimed about 4 times and they paid without issues).
 

WAslayer

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But which one is any good? I haven't ever claimed so I only know who's good at processing debit orders.
Have my gap cover with admed and have claimed multiple times without any issues..
 
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Magandroid

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Thanks for all the replies. Seems we will probably have to do some further research into the various options. We will probably have some more questions later.
 

Meister-Man

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It makes sense to have different providers for gap.
As discovery gap cover might have similar fine print as discovery med aid and then you sit without cover.
Do your due diligence.
 

Nemesys

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If someone has medical aid with, say, Discovery Medical Aid, and want to take out gap cover, must the gap cover be with Discovery or are there other institutions that also offer gap cover?
I am with discovery and previously had my gap cover with Stratum. I claimed a few time from them and never had any problems. I recently switched to Discovery gap cover which is slightly more expensive but there are a few extras not provide by Stratum but the main reason I switched is the seamless claims procedure provided by this combination. The Discovery gap cover pick up when there is claimable event and the claim is processed without any input necessary from you. The money is usually paid into your bank account within a few days after the claim has been processed by Discovery. Previously the claims procedure required a lot of paper work from my side.
 

Ecco

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Can i understand what you guys are typically claiming for from your gap cover provider? Reason for asking is i want to understand if this is something i should be considering for my family.
 

shinji

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Can i understand what you guys are typically claiming for from your gap cover provider? Reason for asking is i want to understand if this is something i should be considering for my family.
Used mine to cover co-payments.
Can also cover shortfall (ie. rates covered etc.) - basically, Medical Aid doesn't cover absolutely everything, Gap Cover covers the "out of pocket" or "shortfall".
 

WAslayer

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Can i understand what you guys are typically claiming for from your gap cover provider? Reason for asking is i want to understand if this is something i should be considering for my family.
If your medical aid pays a specialist at a 100% of the medical aid rate but, the specialist charges 200% of the medical aid rate, you are responsible to pay for the outstanding 100% i.e the co-payment..

This co-payment you can claim from gap cover..

Have successfully claimed for the birth of my two kids all these co-payments..
 

SHL

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Used mine to cover co-payments.
Can also cover shortfall (ie. rates covered etc.) - basically, Medical Aid doesn't cover absolutely everything, Gap Cover covers the "out of pocket" or "shortfall".
So isn't GAP cover the same as 'savings' ?
 

Ecco

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I'm with Discovery for medical aid but found their GAP cover a bit expensive.

My GAP cover is with Sanlam and so far so good ( I claimed about 4 times and they paid without issues).

I see Sanlam Gap cover is R385 pm for families - now I am interested. Because i do have savings on my medical aid, but it ran out half way through the year.

Whats the catch though? Seems too good to be true?
 

WAslayer

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I see Sanlam Gap cover is R385 pm for families - now I am interested. Because i do have savings on my medical aid, but it ran out half way through the year.

Whats the catch though? Seems too good to be true?
Waiting periods, no cover for PMB as this is supposed to be covered by medical aid and most, of not all have a 3 month from event claim period..

Each product is different and you would have to read the policy wording to know what all the catches are..

As I have said, I ha e claimed successfully for all events I needed to claim for..
 

3WA

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It makes sense to have different providers for gap.
As discovery gap cover might have similar fine print as discovery med aid and then you sit without cover.
Do your due diligence.

Wouldn't any gap policy have the condition that a claim is only payable if the medical aid also approves it? Are there any policies that will pay out even for claims that medical aid rejects?
 

Magandroid

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I am with discovery and previously had my gap cover with Stratum. I claimed a few time from them and never had any problems. I recently switched to Discovery gap cover which is slightly more expensive but there are a few extras not provide by Stratum but the main reason I switched is the seamless claims procedure provided by this combination. The Discovery gap cover pick up when there is claimable event and the claim is processed without any input necessary from you. The money is usually paid into your bank account within a few days after the claim has been processed by Discovery. Previously the claims procedure required a lot of paper work from my side.
Thank you Nemesys for this valuable info. Definitely something to consider when making a decision.
 
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