IOL 6th January 2021
While the Covid-19 pandemic may have caused changes in travel plans and will potentially keep more people closer to home, the reality is that accidents abound over this time. From action adventure-related concussion to accidental broken bones, injuries resulting from ‘Do It Yourself’ (DIY) to car accidents, there are many ills that could befall, even if you stay at home. All of these have the potential to result in large out of pocket expenses related to medical treatment. Make sure you have Gap Cover in place to help you handle these unanticipated incidents and ensure that an accident doesn’t ruin 2021 financially before it has even begun.
These accidents could all leave you out of pocket for significant amounts of money, unless you have the right Gap Cover in place. Certain insurance providers offer a casualty benefit for accidents, which covers payment for the facility fee, doctors, radiology pathology, emergency medical intervention and even medication. This provides comprehensive cover for accidents, even if you are not admitted, which otherwise would not be covered by medical aid, or would come out of your savings.
Know your PMBs
Certain conditions are covered as Prescribed Minimum Benefits (PMBs) and this may apply to accidents as well. It is always advisable to understand what PMBs are so that you can make sure your medical scheme is paying your claims effectively. The full list of PMBs and other information can be found here. PMBs are legislated, so it is your legal right to have a PMB condition paid for at cost. This includes the involuntary use of a non-designated service provider (DSP) hospital in the case of life-threatening emergency or a DSP doctor being unavailable.
Remember that drunkenness is a policy exclusion
It is important to remember, especially over the holidays, that anything that happens when you are drunk or abusing drugs is not covered unless it’s a PMB such as alcohol and drug rehabilitation. This means that both Medical Scheme plan benefits and Gap Cover will not pay out in the event of accidents happening to an intoxicated person. Excessive alcohol consumption is a dangerous practice, and it could leave you out of pocket for a lot of money. The transport minister has also announced that government plans to implement a 0% alcohol limit for all motorists by December, so drinking anything and driving could also land you in jail.
Be safe and stay well
Gap Cover not only offers comprehensive cover for accidents, including the casualty benefit, certain policies will even provide a personal accident benefit. This is a lump sum payment for permanent or total disability resulting from an accident when a person is not under the influence of alcohol or drugs. There are also medical scheme contribution and gap premium waivers to cover these expenses for a few months while the patient finds their way.
In the case of death, due to an accident, the remaining dependants can still claim for the personal accident benefit. Furthermore, they can claim for the medical scheme contribution and gap premium waiver if the principal insured person passes away due to an accident.
Gap Cover also provides cover for using non-network hospitals, which otherwise attract quite significant co-payments, as well as an increase in the medical aid rate up to 600% to cover medical expense shortfalls in-hospital. You need to speak to your financial advisor in order to make sure you don’t start 2021 in financial difficulty. This means you need ensure you are covered in the best way possible for accidents and unanticipated medical expense shortfalls.
Turnberry Management Risk Solutions (Pty) Ltd is an authorised Financial Services Provider (FSP no. 36571). Underwritten by Lombard Insurance Company Limited (FSP No 1596)