Cover Magazine – February 2024

Brian Harris, GM Operations at Turnberry Management Risk Solutions

The insurance industry is undergoing a significant transformation, particularly in addressing coverage gaps. One critical element in this paradigm shift is the role played by gap cover. The quest for comprehensive coverage within the confines of affordability has led to the development of diverse medical aid options. However, to keep premiums reasonable, insurers often pass on a significant portion of risk to policy holders. This includes co-payments, penalties for non-Designated Service Providers (DSPs), and reduced coverage for specialist fees. Enter gap cover – a cost-effective solution designed to provide ultimate peace of mind to policy holders.

Technological advancements and their impact on medical cover

Technological advancements are shaping the design and delivery of gap cover solutions in the insurance industry, and South Africa boasts world-class facilities and specialists who leverage cutting-edge technology to provide patients with the best possible outcomes. From robotic surgery to advanced scanning technology and specialised cancer formularies, these innovations come at a considerable cost, and insurance providers need to stay abreast of these technological advancements to ensure that their clients receive the ultimate level of cover.

Strategic financial planning: unveiling the role of gap cover

The incorporation of gap cover contributes to a more comprehensive and effective risk management strategy, and understanding one’s true financial exposure to unforeseen medical events is crucial. While medical aids typically cover 100%-200% of the medical aid tariff, specialists often charge in excess of 400%. Coupled with co-payments and penalties for non-DSPs, this could result in shortfalls running into tens of thousands of Rands. Gap cover acts as a vital safety net, mitigating the financial risks associated with potential shortfalls.

As various industries emphasise hyper-personalisation, insurers are tailoring their gap cover offerings to meet the unique needs of individual clients. In a landscape where members can choose from over 100 different medical aid plans in South Africa, gap cover ensures that every member has an option best suited to their specific scheme and life stage. Policies range from individual coverage to encompassing all dependents, with rates tailored to the policy holder’s age and associated exposure.

Innovations driving success: recent trends in gap cover products

Recent product innovations in gap cover have proven successful, aligning with current trends in the insurance and financial planning sectors. Beyond addressing immediate medical needs, gap cover now extends its benefits to include contributions toward dependents’ medical aid for six months and full gap cover for 12 months after the policy holder’s passing. Proactive measures such as cover for prophylactic mastectomy, robotic surgery, and innovative cancer drugs have significantly improved the lives of policy holders.

Considering the dynamic nature of the insurance and financial planning spaces, staying ahead of the curve involves selecting a gap cover provider with a proven track record. The provider should offer long-term quality service, tailor-made products aligned with offerings, and a robust digital solution for easy access to essential cover. Regulatory considerations, such as the Demarcation Regulations, play a role in setting boundaries between medical aids and supplementary medical insurance. Compliance with underwriting requirements and benefit limitations ensures a balanced and regulated approach to gap cover.

Financial advisors can leverage behavioural coaching trends to enhance their clients’ understanding and adoption of gap cover. The journey begins with awareness, as far too often, individuals only recognise the financial shortfalls associated with medical expenses when an event occurs. Real-life examples with actual costs, rather than hypothetical cases, allow clients to ask crucial “what if” questions and gain a clear understanding of their exposure and available cover.

What is Gap Cover?

Client Testimonials

We had a five star experience throughout our claim submission process. Thank you sincerely for all the support during this process – the entire process was seamless.  I would recommend Turnberry Gap Cover to anyone and everyone without hesitation.  Peter Hunter

Kudos to Turnberry! The best gap cover there ever is. I am super highly impressed with how  fast the turnaround response was. How fast the payout to my bank account was. Absolutely no delays no miss communication no hassles no emailing back and forth, wow wow wow. You guys are superb! I will highly recommend this gap cover to so many of my family and friends. The process for the claim was straight-forward and simple. And literally within the same day you guys paid to my bank account so I can cover the shortfall with my medical aid. I just want to say thank you so much to the claims department. For the new year you guys are on the ball. So efficient. Highly impressed. You can acknowledge my review and please share it with the claims team. Thanks Turnberry gap cover you guys rock.  Raeesa Govender