The Employment Benefits Network – 4th September 2023

Medical aid is a must in South Africa for anyone looking to make use of private healthcare, as the cost for those who are not members of medical schemes is simply out of reach for most people.

However, co-payments, sub-limits and medical expense shortfalls have become increasingly common, leaving people out of pocket even when they do have medical aid. As a result, gap cover has become an essential part of a comprehensive healthcare portfolio, but selecting the right product can be daunting.

When it comes to choosing medical aid as well as gap cover to suit your needs, your life stage and your budget, the right advice is critical.

Step 1: Choosing a medical aid option

Selecting a medical aid scheme and plan option is a personal exercise, as there are many different offerings available from multiple providers and everyone’s circumstances are unique. The right plan depends on your individual circumstances, such as your age and your life stage, as well as your own health. It also depends on affordability and budget factors, as the cost of medical aid can be a significant expense.

It is also important to consider any limitations, additional expenses, exclusions or waiting periods that could apply, which again depends on personal circumstances.

For example, a single, healthy 26-year-old with no children will have very different needs from someone in their mid-fifties with a chronic condition like blood pressure or diabetes, and a basic hospital plan might be sufficient for them, while the person with the chronic condition will need a more comprehensive solution. At the same time, a 26-year-old who is planning to start a family or who has children will also have different requirements from their medical aid.

Sifting through the many different options to find the right one for you can be a challenging task, which is why brokers and financial advisors are available to provide advice.

Filling the gap

There are essentially three core components of gap cover, with the most important one typically being hospital expense medical shortfall cover, as this is where most out-of-pocket expenses originate. The other two essential components are co-payments and sub-limits. It is once again important to also look at exclusions, limitations and waiting periods imposed by the gap cover provider.

Once a medical scheme option has been selected, the ‘holes’ in your cover can be plugged with an affordable gap cover policy that will supplement the medical aid option you have chosen in terms of these three areas. If your chosen medical aid option includes large co-payments then it is critical for your chosen gap cover to have substantial co-payment cover, for example. All medical aid schemes and options differ when it comes to these elements, so it is vital to find a gap policy that fits well to supplement your cover.

There are also a range of value-added extras that gap cover providers may offer, including a casualty benefit to cover the expenses of a visit to the emergency room, counselling benefits and premium waivers. Again, the advice of a broker or financial advisor can be invaluable in helping you select the right gap cover policy to suit your needs as well as your chosen medical scheme plan and option.

One size does not fit all

The reality is that there is no single solution that will meet everyone’s circumstances, lifestyle, life stage, age, budget, and other needs. Everyone is different, and to effectively protect your financial future, it is essential to get the right fit. Expert advice can go a long way in making sure you have the best medical aid cover you can afford – and the services of a broker are included as part of medical schemes, so there are no additional fees for making use of this service. Your broker can also help you to find the most appropriate gap cover to fit your unique individual needs.

The right advice is key in selecting medical aid and gap cover to suit your needs | EBnet



What is Gap Cover?

Client Testimonials

Turnberry assisted with claims for various incidents during the last few years – from an elective orthopaedic surgery for my young daughter to emergency surgeries for my wife.   When my wife was diagnosed with cancer last year, the once-off payment assisted in a number of the out-of-hospital expenses. In addition, the knowledge that the expenses threshold is so much higher than the standard medical rates provided peace of mind.  I have recommended Turnberry Gap Cover to our family, and reiterate that it is an essential or mandatory product. No healthy person believes critical or emergency procedures will happen. But the truth is that it can happen to anyone. The cost vs benefit is not a logical debate, without gap coverage you may end up selling assets to cover the bills.   Turnberry’s services were professional, quick and efficient – ‘Peace of mind’.        Mynhardt Oosthuizen

The claiming process was easy and painless. The claim was finalised quickly. This was a huge relief as, having been diagnosed with cancer, it was one less thing to worry about.  Make sure that you have GAP cover. It could be the difference between being able to pay all your medical accounts and having to go into debt to cover the unexpected costs.