What Are Gap Cover and Top-Up
Many people want to know just what are gap cover
and top-up plans? They are not sure if they need such plans or not, because they argue that they are already paying
a hefty premium for the best medical aid. Medical aids have to make sure that they have enough funds to cover the
health care needs of their members.
In recent years, however, the fees charged by medical practitioners and
specialists have skyrocketed and most medical schemes simply cannot pay these fees. This situation has forced
them to limit the amount that they will pay for any given treatment or procedure.
In many cases the fee charged by the specialist or
hospital is as much as four hundred percent above the amount that will be paid by the medical aid. It needs no
degree in rocket science to figure out that the shortfall between the fee of the medical facility and the amount
that will be paid by the scheme will leave the patient out of pocket. In fact, the shortfall can be financially
Is there a
The short answer is “yes”. The Short-Term
Insurance act no 53 of 1998 addresses the issue by allowing short term insurance companies to offer special
products called Accident and Health policies. These products are designed to pay for the shortfall between the
medical aid coverand the account tendered by the treatment facility or the medical
Most insurance companies offer a wide variety of
products that addresses this problem. In many cases members of existing medical aids can even obtain additional
cover from their existing schemes. Those that are not members of a scheme can consider a hospital plan that makes
provision for hospitalization but not for day-to-day medical care.
Do some homework before
making a decision!
There is a bewildering array of products that
provides for hospital cover, cash payments in cases of hospitalization and payments to cover the gap between the
amount paid by the scheme and the actual cost of the treatment. Consumers should be sure to conduct thorough
research before making a decision about gap
cover. Here are some pointers:
- It is no use investigating additional cover
unless one is perfectly up to date about exactly what cover is already in place. It is therefore vital to study
the terms and conditions of existing medical plans. It is a good idea to ask advice and to do online research
to find out just what the cost of medical treatment in and out of hospital is.
- Ask different insurance companies to provide
a written quotation. In order to compare apples with apples, it may be wise to ask them to provide their
quotations in a standard format.
- There are some excellent websites that will
obtain a number of standard quotations from various service providers. They normally present their results in
an easy-to-read and easy-to-compare format. A simple search using keywords such as “hospital plan”, “gap cover”
or “top-up plans” will produce the desired results.
Many people that pay high premiums for the medical
aids are irked by the need to take out additional cover. The ethics of the system is a matter of some on going
controversy, but that will be of very little help when calamity strikes and large hospital bills become due.
Without such cover consumers can easily be ruined financially. © Medical Aid Plan