Question about medical aid gap cover

[shinji]

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?

Yes - a rejected claim by the Medical Aid is not covered by the GAP Cover.

Gap Cover is effectively "Shortfall Insurance" that pays for Co-payments and Shortfalls in Cover. It does not cover claims that are not approved, nor do they cover an indefinite shortfall (it merely boosts cover in many cases).
The Gap Cover I had (which I'll reactivate in 2022) covered the R4000 Co-payment I had for getting my wisdom teeth removed in hospital under anaesthesia (which was a freaking boss move) - I had to pay the Co-payment at admission and claimed it back after getting pre-authorisation from the Gap Cover people. Payout to about 10 days.

The Savings part of your Medical Aid covers a small part of Day-to-Day use and/or medicine (and is a total piece of BS to be honest). Rather get Gap Cover and research a decent Medical Aid with Day-to-Day benefits instead of a Savings Plan. I have heard way too many people complain that their Medical Aid is exhausted by the middle of the year.
I'm on a hospital plan with Medshield that have Day-to-Day benefits included (up to R5700 per year plus specialised Dentistry to R6300 per year plus a few smaller benefits) any doctor or dentist. Can visit virtually any hospital in SA, no network BS. Pay R2350 p/m.
DO PROPER RESEARCH.

Medical Insurance is a little bonus money when you go to hospital - check the Clientele ads...
They don't cover medical expenses but rather pay an amount per day (only after staying for 2 days etc. etc.) you can use to pay bills, have a braai, pay back the family and so on.

There aren't any policies that will cover hospital stays, operations or procedures if Medical Aids rejects the claim. There are very strict guidelines that govern Medical Aids and prescribe the cover and how it's administrated. Many policies even cover Drug Overdose, Rehabilitation and Psychiatric Observation.
It is your duty to research the best package for your (and your family's; if applicable) needs. You also have to check the changes the Medical Aid makes to your cover year on year, to be sure you are properly covered.

Gap Cover offers peace of mind for big procedures where the cost becomes a minefield. Medical Aids are businesses and they will try to save where they can - Gap Cover simply puts a star player on your team to even the odds a bit.

TL;DR - Gap Cover pays shortfall Medical doesn't.
No Insurance will pay if Medical Aid rejects the claim.

 

[diapason]

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?

Savings are for day to day expenses. Gap is for shortfall on major medical expenses, i.e. hospitalisation. Some gap covers have add-on options which cover things like co-payments on various procedures which can be done in a doctor's rooms, or emergency hospital visits which don't result in being checked in overnight, IOW they just turn out to be expensive consultations.

 

[Moto Guzzi]

With different provider. So far the Gap cover worked better than the Medical Aid, it work as the Medical Aid should have in the sense I got more than I paid which is as it should have been in the 1st place.
My current Medical Aid(Previous one went bancrupt after adopting New Norm practises and was absorbed by this one) suggested a Gap Cover initially, and thats where I am still.

 

[TurkeyMan]

So isn't GAP cover the same as 'savings' ?

People have already answered this, but I want to make an additional point. People often think the savings account is a benefit given to you by the medical aid. Its not.
Your savings account is funded by a portion of your monthly premium paid by you to the medical aid (for my plan with Discovery its 25%). They just let you access the full amount from the beginning of the year, effectively loaning you that money until you've paid it off at the end of the year via your premiums.

Meaning that if you don't use day-to-day benefits very often, get a plan without a savings account and do something smarter with that money (like paying for gap cover).

 

[Meister-Man]

People have already answered this, but I want to make an additional point. People often think the savings account is a benefit given to you by the medical aid. Its not.
Your savings account is funded by a portion of your monthly premium paid by you to the medical aid (for my plan with Discovery its 25%). They just let you access the full amount from the beginning of the year, effectively loaning you that money until you've paid it off at the end of the year via your premiums.

Meaning that if you don't use day-to-day benefits very often, get a plan without a savings account and do something smarter with that money (like paying for gap cover).

Good point.
If I didn't have the company match, I would also go for a medical aid plan without the savings.