If you have recently been hospitalised or undergone a medical procedure, you may have been faced with a bill from your doctor which was not fully covered by your medical aid scheme. As medical costs rise well above inflation, many medical specialists now charge fees in excess of the rate paid by even a fully comprehensive medical scheme option.
Moreover, in order to keep premium increases as low as possible, many schemes are also introducing co-payments for certain elective procedures. These are all contributing towards an increase in the self-payment gap, which means more and more of our medical costs will be borne out of our own pocket.
As specialist fees continue to increase, so will this gap continue to widen. This trend is of particular concern for older medical scheme members who may require more frequent specialist treatment.
For this reason, medical gap cover is becoming a popular way to supplement one’s medical cover. Gap cover is a short-term insurance policy that pays out the difference between your medical bills and what your scheme covers for a relatively low premium. As gap cover relates directly to medical scheme cover, an individual must be a member of a medical aid scheme in order to purchase this type of policy.
Not all gap cover insurance provides the same benefits, so it is important to understand exactly what your gap cover will pay for, as different benefits are covered depending on the option selected.
Eight questions you need to ask:
- Is there an age limit?
- How many members of my family does it cover?
- Are there any medical underwriting requirements?
- Will it cover co-payments on elective procedures?
- What is the maximum amount that will be paid?
- Does it cover both in-hospital and out-of-hospital events?
- Are there any exclusions or waiting periods?
- Does it provide additional cover for cancer?
Liberty Medical Gap Cover (underwritten by Guardrisk Insurance Company Limited) offers three options depending on the policyholder’s needs and affordability, and is available to members of any medical scheme.
- Universal Medical Gap Cover: R281 per family
- Standard Medical Gap Cover: R262 per family
- Core Medical Gap Cover: R219 per family
All three options cover the main medical scheme member and their family and have no age limit and no restriction on the number of children covered, nor are there any medical underwriting requirements.
Cover provides for up to 500% of the medical scheme tariff (MST) for in-hospital doctor and specialist charges. This would include GPs, specialists, surgeons, anaesthetists, radiologists, and pathologists. This cover is provided without an annual maximum claim limit.
For outpatient procedures, there is an extensive list of procedures that are covered and again, cover is up to 500% of the MST without an annual maximum claim limit.
Liberty Medical Gap Cover can also be used where co-payments are required for certain elective procedures, such as a colonoscopy.
Universal and Standard Medical Gap Cover options have additional cover for cancer treatment, including R25 000 paid out on the first-time diagnosis of cancer and which is not dependent on actual treatment costs. In the case of breast cancer, there is additional cover of up to R20 000 for surgical costs that are not covered by your medical scheme for cosmetic breast reconstruction.
Universal Medical Gap Cover also includes additional casualty cover for in-hospital casualty ward treatment of up to R5 000 per year.
Speak to your financial adviser about the appropriate cover for your needs. |
