26 Feb Debunking gap cover myths: What you really need to know about GapCover

Debunking gap cover myths: What you really need to know about GapCover®

There are many assumptions about medical expenses in South Africa; most South Africans assume that a medical aid is enough to pay for all the costs of their healthcare. There may, however, be unanticipated shortfalls that could leave an individual out of pocket. The issuing of GapCover® is therefore vital; nevertheless, many misconceptions exist about what exactly gap cover is and how it actually functions. Let’s take a look at clearing out some of these myths regarding medical aid (and) gap cover and explore the benefits of gap cover.

Myth #1: If I have medical aid, I don’t need GapCover®

Although medical aid schemes reimburse all services rendered according to a predetermined tariff, procedures and services by specialists and hospitals could go above those tariffs, leaving the extra costs of such services on the patient’s shoulders. Gap cover South Africa then acts by covering that

Myth #2: GapCover® covers all medical expenses, including day-to-day costs

GapCover® deals with in-hospital shortfalls and specific prescribed procedures. It doesn’t cover every day medical expenses, which comprise consultations with doctors, prescription medication, or dental treatment. Such expenses would ordinarily be taken care of by the savings plans of the medical aid or paid out of pocket

Myth #3: GapCover® pays the hospital directly

One of the benefits of gap cover is that it reimburses the insured once they have settled the bill; unlike medical aid that pays a healthcare provider directly. A claim must be submitted by the insured and a payout receivable for the amounts that are covered.

Myth #4: There are no limits on how much GapCover® will pay

GapCover® does have annual limits and benefit caps, depending on the policy. While it can significantly reduce financial stress, understanding these limits ensures realistic expectations regarding cover.

Myth #5: You can take GapCover® without having medical aid

GapCover® is not a stand-alone product. Just individuals who hold a registered medical aid plan are able to purchase gap cover in addition to their medical aid. It is a complement to pre-existing medical aid cover that pays for certain shortfalls occurring in-hospital but does not take the place of medical aid cover itself.

Myth #6: GapCover® covers procedures under Prescribed Minimum Benefits (PMBs)

PMBs are legally required to be covered by medical schemes, but additional costs related to these procedures (e.g., specialist fees above scheme tariffs) may still arise. Gap Cover for those in South Africa helps cover these additional costs but does not duplicate PMB cover.

Myth #7: GapCover® is only for older people

Surprise medical bills strike everyone, regardless of age. A younger person could very well require a surgical procedure, an emergency treatment, or refer it to a specialist whose rates are far above that paid by the medical aid. Thus, GapCover® becomes even more relevant at all ages.

Myth #8: GapCover® is complicated and hard to claim from

The claims process for GapCover® is straightforward. Policyholders submit their claims along with the necessary documents, and reimbursements are processed efficiently. Dedicated support teams are available to assist throughout the process.

Myth #9: GapCover® is too expensive to be worth It

The understanding of many is that gap cover is a luxury; but normal economists would argue that it could save thousands of rands for the policyholder when hit with unexpected medical bills. Compared to the potential costs of uncovered procedures, medical aid gap cover is an affordable alternative and a great financial investment.

Making an informed choice

Understanding what gap cover South Africa has in it and what is rejected is crucial to making informed decisions regarding your healthcare. If you would like more information on how to manage your medical expenses and the benefits of gap cover, have a look at our other blogs dedicated to smart healthcare planning and financial wellness.

For more details or to sign up, visit GapCover.co.za.