With the rising costs of medical care, health cover has become an essential monthly expense.
Even those who can afford day-to-day medical expenses such as GP visits can scarcely afford a hospital stay or out-patient treatment for a serious disease. One study, for example, showed that the average cost of hospital admissions for COVID-19 cases was over R75 000, climbing to over R100 000 for intensive care.
Selecting a medical aid has become an overwhelming endeavour.
Not only do you have to choose between a medical aid or health insurance, but there are several providers – each with numerous plans and options. This is further complicated by differing waiting periods, condition exclusions, PMB conditions and other jargon, leaving most people wondering if they are adequately covered. Unfortunately, it is often only when you really need it that you may discover your plan’s shortfalls.
At Graham Silva Insurance, our consultants keep abreast of constantly changing benefits and plans so that we can provide you with up-to-date advice on options that suit your needs and pocket. Let us help you decide whether a comprehensive plan with day-to-day benefits or a simpler plan covering mostly hospital costs suits you as an individual or family – and whether you should consider gap cover as well.
As registered brokers for four of SA’s leading medical aids and two gap cover specialists, we’re able to assess, compare and recommend a package offering you the most benefits and value for your money.
Gap Cover
Gap cover is a short-term insurance product that covers medical aid shortfalls.
Medical aid schemes in South Africa typically reimburse healthcare providers at 100%, 200%, or 300% of the prescribed scheme rate, depending on the client’s plan. Yet providers may charge up to five times these rates.
One gap cover client’s dislocated shoulder cost more than R42 000 to heal, for example, while the medical aid payment was just over R10 000. Gap cover took care of the R32 000 outstanding balance. Furthermore, medical aid schemes require co-payments from clients on certain plans or if they use providers outside the scheme network. Gap cover pays this co-payment, up to a certain amount per year. In the example of the dislocated shoulder, the hospital co-payment was almost R4 000, and gap cover again took care of it. With suitable gap cover, you’ll also qualify for lump sum benefits in certain medical cases, giving you added peace of mind.
As brokers for both Turnberry and Stratum medical shortfall insurers, we’ll help you choose the gap cover policy best suited to your current medical aid plan to ensure you have full cover, including specialist rates, co-payments, pathology, anaesthetists, out-of-pocket deductibles, and enhanced cancer cover.