{"id":1589,"date":"2017-01-25T11:49:36","date_gmt":"2017-01-25T11:49:36","guid":{"rendered":"https:\/\/turnberry.co.za\/2023\/new\/?p=1589"},"modified":"2024-01-10T08:14:02","modified_gmt":"2024-01-10T08:14:02","slug":"the-grey-in-the-gap-risk-africa-magazine","status":"publish","type":"post","link":"https:\/\/turnberry.co.za\/2027\/the-grey-in-the-gap-risk-africa-magazine\/","title":{"rendered":"The Grey in the Gap \u2013 Risk Africa Magazine"},"content":{"rendered":"<h3 class=\"p1\">Rates in the medical field are a continued topic of hot debate in the industry, particularly given the government\u2019s stance on the matter.<\/h3>\n<p><img decoding=\"async\" class=\"wp-image-1595 size-full alignleft\" src=\"https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/main.jpg\" alt=\"Grey in the gap\" width=\"400\" height=\"\" srcset=\"https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/main-200x109.jpg 200w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/main-300x164.jpg 300w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/main-400x219.jpg 400w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/main-600x328.jpg 600w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/main.jpg 640w\" sizes=\"(max-width: 640px) 100vw, 640px\" \/>Article by Nicola Jenvey<\/p>\n<p>(Excerpt from\u00a0<a href=\"https:\/\/www.riskafrica.com\/the-grey-in-the-gap\/\" target=\"_blank\" rel=\"noopener\">Risk Africa Magazine<\/a>)<\/p>\n<p>Medical aid schemes are controversial monthly insurance expenses, from the government berating that the most of South Africa\u2019s medical fraternity are ensconced in private practice and providing services to a privileged minority to the percentage that those payments consume of members\u2019 disposable income and what they receive in return.<\/p>\n<p>But escalating private medical practice costs have meant that while contributions have increased, the benefits covered have diminished as specialists\u2019 rates have climbed more swiftly than the reimbursements.<\/p>\n<p>Into that milieu entered the short-term <a href=\"https:\/\/turnberry.co.za\/2027\/products\/\">gap cover insurance<\/a> concept \u2013 insurance against being out of pocket when interactions with specialists become something scheme administrators are not prepared to cover in full.<\/p>\n<p>Gap cover provides the difference between what medical aids pay for in-hospital procedures in line with the National Health Reference Price List (NHRPL), as maintained by the Department of Health and the Council for Medical Schemes, and what doctors actually charge. If the medical aid pays out 100 per cent of the medical aid (or NHRPL) rate and the specialist charges three times that amount, members are responsible for the difference.<\/p>\n<p>Bull\u2019s Eye Financial Services Group executive Vanessa Roux says South African specialists are not regulated on the rates they can charge, meaning patients pay the shortfall from their pockets. That amount may be 500 per cent of the rate the scheme is prepared to cover.<\/p>\n<p>\u201cGap cover providers are under increased pressure from <a href=\"https:\/\/turnberry.co.za\/2027\/in-the-wake-of-the-latest-medical-scheme-updates-can-you-afford-not-to-have-gap-cover\/\">medical schemes<\/a> in terms of benefit design and some service providers, who change their billing practices according to whether or not policyholders have additional insurance provisions,\u201d Martin Rimmer, CEO of Sirago Underwriting Managers, is on record for stating, effectively throwing down the gauntlet to the industry.<\/p>\n<p>Sebastian Zoutendyk, director at Zestlife, says that the expectation by medical aid members that their scheme will wholly cover their hospitalisation costs is seldom met. Benefits are limited to their medical scheme tariffs (MST), but medical practitioners can demand considerably more than the MST. \u201cThis charge creates a shortfall the medical scheme does not cover and the actual charges of many procedures performed by surgeons, anaesthetists and others can add up to sizeable payment gaps,\u201d he says.<\/p>\n<p>Zestlife schemes include in-hospital procedures up to 500 per cent; outpatient cover for more than 50 procedures \u2013 irrespective of these being performed in-hospital or at an out-patient facility; copayments for hospital admissions; non-designated service provider (DSP) hospital copayments expressed in rands rather than as percentages as well cancer treatment, internal prosthesis, casualty, dental, accidental death, permanent disability and medical premium waivers.<\/p>\n<p><strong>Tony Singleton, CEO of Turnberry Management Risk Solutions,<\/strong>\u00a0says members applying for gap cover are subject to waiting periods if they have not previously had these policies. Typically, a three-month general waiting period applies to all benefits with the exception of those providing cover for up to 500 per cent should the policy commencement be in line with the medical scheme\u2019s commencement date. Pregnancy and childbirth has a nine-month waiting period, while a 12-month period applies to hysterectomies \u2013 unless there is a proven malignancy, hysteroscopy and endometrial ablations, joint replacements and spinal surgery or treatment \u2013unless sustained in an accident, tonsillectomies, grommets, adenoids, wisdom teeth and hernia treatment or surgery \u2013 unless due to emergency surgery. Pre-diagnosed <a href=\"https:\/\/turnberry.co.za\/2027\/comprehensive-breast-cancer-treatment-goes-beyond-medical-procedures\/\">cancers are covered<\/a> provided the person has been in complete remission for five years.<\/p>\n<p>Bryan Hirsch, director at Bryan Hirsch Colley &amp; Associates, says that as South Africans cut their expenditure, healthcare has\u00a0<img decoding=\"async\" class=\"alignright size-full wp-image-1603\" src=\"https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/grey-in-the-gap.jpg\" alt=\"Grey in the Gap\" width=\"400\" height=\"\" srcset=\"https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/grey-in-the-gap-200x109.jpg 200w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/grey-in-the-gap-300x164.jpg 300w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/grey-in-the-gap-400x219.jpg 400w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/grey-in-the-gap-600x328.jpg 600w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2017\/01\/grey-in-the-gap.jpg 640w\" sizes=\"(max-width: 640px) 100vw, 640px\" \/><br \/>\ntaken centre stage. Most medical schemes have unlimited overall benefits and members believe they are covered for major illnesses for whatever benefits they need to claim. However, Clayton Samsodien, MD of Genesis EB Solutions, says a more detailed analysis of scheme structures shows many benefits have sub-limits \u2013 only covering parts of the procedures. Sub-limits may mean a procedure will only be covered in the public sector. \u201cMembers must find a marriage between their medical aid schemes and their gap cover options,\u201d he says.<\/p>\n<p>For the full article \u2013 please follow this link:\u00a0<a href=\"https:\/\/www.riskafrica.com\/the-grey-in-the-gap\/\" target=\"_blank\" rel=\"noopener\">Risk Africa Magazine<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Medical aid schemes are controversial monthly insurance expenses, from the government berating that the most of South Africa\u2019s medical fraternity are ensconced in private practice and providing services to a privileged minority to the percentage that those payments consume of members\u2019 disposable income and what they receive in return.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[7],"tags":[],"class_list":["post-1589","post","type-post","status-publish","format-standard","hentry","category-news"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Does Gap Cover Really Minimise Risk?<\/title>\n<meta name=\"description\" content=\"Gap cover provides the difference between what medical aids pay for in-hospital procedures and what doctors actually charge.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/turnberry.co.za\/the-grey-in-the-gap-risk-africa-magazine\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta 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