GAP COVER – an essential portion of your health care cover
As you probably experienced already, most of the time after you’ve been in hospital or had a medical procedure done, there is usually an amount that the Medical Scheme doesn’t cover and which you have to pay in, that is what we call the shortfall OR GAP! Read further to understand why having Gap Cover is a good decision.
Even though the medical scheme covers your in-hospital procedures, you are still exposed to the risk of large out of pocket payments for in-hospital procedures.
Specialists charge 300 – 500% more than what your medical scheme pay for in-hospital procedures. These shortfalls can vary from a few thousand rand to tens of thousands of rand. It can be R10 000 or R50 000 or even more.
Listed below are four common medical procedures, with the combined charges of the specialist and anaesthetist. In the third column the shortfalls not covered by the medical scheme are listed.
|Procedure||Amount charged by Practitioner||Potential shortfall incured (Payable by Gap Cover*)|
|Colonoscopy||R 14 509.82||R 4 805.42|
|Back Fusion||R81 499.11||R27 949.89|
|Shoulder Operation||R19 081.86||R11 958.34|
|Joint Replacement||R46 660.48||R23 597.41|