{"id":1985,"date":"2018-06-15T15:05:04","date_gmt":"2018-06-15T15:05:04","guid":{"rendered":"https:\/\/turnberry.co.za\/2023\/new\/?p=1985"},"modified":"2024-01-10T08:13:03","modified_gmt":"2024-01-10T08:13:03","slug":"what-gap-cover-doesnt-cover","status":"publish","type":"post","link":"https:\/\/turnberry.co.za\/2027\/what-gap-cover-doesnt-cover\/","title":{"rendered":"What Gap Cover doesn&#8217;t cover?"},"content":{"rendered":"<p><img decoding=\"async\" class=\"alignright wp-image-1927 size-medium\" src=\"https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2018\/04\/surgeon1-300x249.jpg\" alt=\"What Gap Cover doesn't cover?\" width=\"300\" height=\"249\" srcset=\"https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2018\/04\/surgeon1-200x166.jpg 200w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2018\/04\/surgeon1-300x249.jpg 300w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2018\/04\/surgeon1-400x332.jpg 400w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2018\/04\/surgeon1-600x499.jpg 600w, https:\/\/turnberry.co.za\/2027\/wp-content\/uploads\/2018\/04\/surgeon1.jpg 722w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>South African consumers are becoming increasingly aware of Gap Cover: a type of insurance that augments one\u2019s Medical Aid, helping to cover in-hospital medical expense shortfalls for certain procedures and specialist bills.<\/p>\n<p>With many hospitals and specialists charging multiple times the stipulated Medical Aid rates, Gap Cover has emerged as a way to protect consumers against significant medical expense shortfalls, with <a href=\"https:\/\/turnberry.co.za\/2027\/products\/\">reasonable premiums<\/a> of up to a few hundred rand per month for the more comprehensive offerings.<\/p>\n<p>However, many consumers aren\u2019t always aware of exactly what their Gap Cover policy entails\u2026 what they are covered for, and what they aren\u2019t.<\/p>\n<p>Tony Singleton, CEO of Turnberry Risk Management Solutions, stresses the importance of avoiding any nasty surprises, and knowing exactly what to expect at the claims stage. He says consumers should immerse themselves in the details of their policies.<\/p>\n<p>\u201cTo truly know what your Gap Cover will offer you, the starting point is to fully understand your Medical Aid,\u201d he advises.<\/p>\n<p>\u201cGap Cover products can only address medical expense shortfalls for something that has been partially covered by your Medical Aid. So, if your Medical Aid doesn\u2019t cover a certain procedure or specialist bill at all, then your Gap Cover isn\u2019t able to assist.\u201d<\/p>\n<p>This is the manner in which the industry has been regulated and constructed, he explains, in order to clearly delineate between the role of Medical Aid and Gap Cover.<\/p>\n<h2><strong>Devil\u2019s in the details<\/strong><\/h2>\n<p>Singleton says consumers should rely on the services of a trusted financial advisor , to help them find a Medical Aid and Gap Cover policy that suits their (or their family\u2019s) unique needs.<\/p>\n<p>\u201cAside from this, it\u2019s helpful to go through your member plan guide, product brochures and medical scheme rules \u2013 for both your Medical Aid and your Gap Cover &#8211; to ensure you\u2019re fully informed about what is and isn\u2019t covered.\u201d<\/p>\n<p>Medical Aid and Gap Cover providers generally update their policies on an annual basis, and consumers should remain aware of any changes to the policy.<\/p>\n<p>As the nature of one\u2019s family changes (such as having more children) or as certain health conditions change, one should re-evaluate their Medical Aid and Gap Cover choices, adds Singleton.<\/p>\n<h2><strong>Likely exceptions<\/strong><\/h2>\n<p>Across the industry, there are a number of treatments that Medical Aids and Gap Cover providers are unlikely to cover.<\/p>\n<p>These include the likes of cosmetic surgeries, so-called &#8216;self-inflicted&#8217; medical concerns (such as alcohol and drug abuse, obesity treatment, attempted suicides, and the like), anything involving the member committing a criminal act, laser eye surgery, dental implants, and infertility treatment, among many others.<\/p>\n<p>But there certainly are some greyer areas. Singleton explains that Medical Aid and Gap Cover providers look to understand whether a procedure is medically necessary, as they review claims that are submitted.<\/p>\n<p>\u201cSo, for instance, breast reconstruction <a href=\"https:\/\/turnberry.co.za\/2027\/fighting-cancer-your-top-9-weapons\/\">post cancer-related<\/a> mastectomies, or reconstructive facial surgeries after an accident, may well be covered by one\u2019s Medical Aid and Gap Cover policies.\u201d<\/p>\n<p>Psychiatric treatment is another area where different Gap Cover providers adopt different positions, so it\u2019s important for consumers to understand the details of their own policies.<\/p>\n<p>There are a number of specialist fields \u2013 such as those whose jobs expose them to nuclear material, or those in active military service \u2013 which may also fall outside the coverage scope of Medical Aids and <a href=\"https:\/\/turnberry.co.za\/2027\/products\/\">Gap Cover policies<\/a>.<\/p>\n<p>But it\u2019s not just about what is and isn\u2019t covered. Singleton says that to ensure claims are paid successfully, it\u2019s essential to follow the rules of one\u2019s Medical Aid, such as gaining pre-authorisation for a certain procedure. If consumers incur additional penalties for not following such rules, Gap Cover is unlikely to foot these bills.<\/p>\n<p>\u201cAnother important consideration is that local Medical Aid and Gap Cover generally only covers one for incidents within the borders of South Africa,\u201d he adds. \u201cFor those that are <a href=\"https:\/\/turnberry.co.za\/2027\/gap-cover-and-travel-insurance-is-a-must-during-holiday-seasons\/\">travelling overseas<\/a>, it\u2019s important to take out additional travel insurance products to deal with any emergencies or incidents that may happen while one is away.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>South African consumers are becoming increasingly aware of Gap Cover: a type of insurance that augments one\u2019s Medical Aid, helping to cover in-hospital medical expense shortfalls for certain procedures and specialist bills. With many hospitals and specialists charging<\/p>\n","protected":false},"author":5,"featured_media":1927,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[7],"tags":[],"class_list":["post-1985","post","type-post","status-publish","format-standard","has-post-thumbnail","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>Exactly What Does Your Gap Cover Entail?<\/title>\n<meta name=\"description\" content=\"See how gap cover protects consumers against significant medical expense shortfalls, with reasonable premiums per month.\" \/>\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\/what-gap-cover-doesnt-cover\/\" \/>\n<meta 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