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Choosing a Medical Aid in South Africa


 

  

  

What are gap cover and top-up plans? All you need to know

What are gap cover and top-up plans? We will have a look at these products and how to use them to your benefit.  

What are gap cover and top-up plans?Most private medical service providers charge a lot of money, some up to 300% of medical aid rates or the maximum rates your medical aid will pay. The difference in these rates will be due by you the patient. To help you pay for this, insurance companies created gap cover for medical aid. 

Gap cover for medical aid and top up medical cover are two different forms of complementary medical aid cover that can be used in addition to your current medical aid. 

What are gap cover and top-up plans? 

Medical gap cover is an insurance policy that covers the difference between the ceiling rates that your medical aid and the amount that the medical service provider charges. 

Top-up cover is an insurance policy that covers your medical aid costs should your medical aid benefits run out before the end of the year. Top up cover can also be used to cover some of the deposits certain medical aid schemes require for examinations and procedures. 

Factors to take into consideration when you want to purchase gap or top-up plans: 

• What are the benefits your medical cover provides and would you need extra cover should it be insufficient? Be sure you know the amount of cover you have, it might be enough and you would not need additional cover. 

• What are the ceiling rates your medical aid plan pays out? A plan with higher ceiling rates might mean that you do not need gap cover. 

• Does your medical aid offer a medical service provider network?  Most medical aids have network options where the rates are negotiated with the service provider. By using the services of a network service provider you will be covered for the rates they charge and would not need additional cover.  

• Do I have enough options? Make sure you get as many quotations as possible to ensure you make an informed decision regarding additional gap or top up cover. 

Additional options available to gap and top up cover: 

• Additional hospital cover or hospital insurance might be an option. With hospital insurance you will receive a cash payout for the days you spend in hospital; this cash can be used to cover the additional medical costs. 

• Consider a better medical aid plan. A better plan might give you the benefits you need. If you compare the quote for a better plan with the quotes for the additional cover you might find that a plan upgrade might cost you less than purchasing additional cover. 

A review: What are gap cover and top-up plans? They are plans to provide additional cover should your medical aid rates not cover the doctor’s rates or if your medical aid runs out before the end of the year. Take all the factors involved into consideration before you purchase gap or top-cover. A medical aid plan upgrade might cost you less. © Medical Aid Plan.