18 Feb Top 5 Medical Expenses Most Commonly Underestimated (And How GapCover Protects You)

Without a doubt, even the most organised person can be caught unaware when it comes to medical expenses. In fact, even a comprehensive medical aid might still leave patients with extensive out-of-pocket payments for procedures performed in the hospital. This is where GapCover saves the day financially-it saves you and your family from potentially falling into a financial pit.

Here are the most underestimated in-hospital expenses for patients and how GapCover protects you:

1. Specialist Fees Exceeding Medical Aid Tariffs

Specialists can charge up to 500% more than what your medical scheme reimburses. For example, suppose you have a medical scheme that allows you 100% of the tariff but the specialist charges at 300%. You could find yourself having to cough up a shortfall of thousands of rands.

How GapCover Helps:

GapCover pays the difference between the medical aid tariff and the specialist’s private fee, covering shortfalls of up to R198,660 per beneficiary per year. This means no surprises after your procedure, just peace of mind.

2. Co-Payments for In-Hospital Procedures

Almost all medical aids require co-payments for surgery or scopes. Hence patients are responsible for paying part of the costs upfront. Such payments will usually amount to anything from R2,000 to even R15,000 depending on the treatment.

How GapCover Helps:

With the Combined Cover option, both the medical expense shortfalls and co-payments for in-hospital and specialised outpatient procedures like CT scans or MRIs are covered.

3. Sub-Limits on Prosthetics and Radiology

Sub-limits imposed by medical aids on internal prosthetics (like knee or hip replacements) or specialised radiology often mean patients have to pay the excess cost themselves.

How GapCover Helps:

GapCover Elite includes a sub-limit benefit to cover these gaps. A gap cover sub-limit is a limit set by a medical scheme on the benefits it provides. This acts to prevent any additional expenses.

4. Costs for Oncology Treatments

Cancer treatments are among the most expensive medical procedures, often requiring multiple rounds of care, and medical aid schemes may not cover the full extent of the expenses.

How GapCover Helps:

GapCover Elite provides an oncology benefit, bridging the gap for non-designated service provider (DSP) specialists and additional costs, so you can focus on recovery without worrying about unpaid bills.

5. Shortfalls for Diagnostic Scopes (Gastroscopies and Colonoscopies)

Diagnostic procedures like gastroscopies or colonoscopies are sometimes performed in doctors’ rooms rather than hospitals, leading to tariff shortfalls of up to 500%.

How GapCover Helps:

Both the Primary and Elite plans cover shortfalls for these procedures, ensuring you don’t have to pay out-of-pocket. With GapCover Elite, cover extends up to 500% of the scheme tariff for two scopes per beneficiary annually.

Why Choose GapCover?

Hassle-Free and Affordable

GapCover is easy to access, with policies starting at just R267 per family per month. One price covers you and up to six family members.

Comprehensive Options

GapCover offers multiple plans tailored to your needs:

• Primary Plan: Ideal for first-time clients or those scaling down, with 300% cover.
• Elite Plan: For maximum protection, including oncology and sub-limit benefits.
• Combined Cover: Combines GapCover and CoPay Cover, this means no shortfalls on tariffs or procedural co-payments.

Quick Claims and Peace of Mind

Benefit confirmation before planned procedures ensures you’re prepared financially, and claims are settled promptly, so you can focus on recovery.

Final Thoughts

Health-related costs may be under-calculated and eventually burden you with stress, but they need not. GapCover has been empowering South Africans to access quality healthcare without hidden costs. Whether you are preparing for a planned procedure or opting to safeguard your family’s future, GapCover is the safety net that you want to have.

Secure GapCover today and remain free from unexpected medical expenses that could be detrimental to your financial well-being so avoid those costly surprises.