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.
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
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
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
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
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
• 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
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
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.