Your medical history is personal, but it can also be important when it comes to understanding your Gap Cover.
Previous conditions, treatments and planned procedures may affect how certain policy terms or waiting periods apply. That’s why it’s important to understand your cover from the start, rather than waiting until you need to claim.
The good news? It doesn’t have to be complicated.
Here’s what you need to know about your medical history and your Gap Cover.
Why can your medical history matter?
Gap Cover is designed to work alongside your medical scheme and help cover certain eligible shortfalls and co-payments when your medical scheme doesn’t cover the full cost.
However, taking out Gap Cover doesn’t necessarily mean every medical expense will immediately be covered.
Depending on your policy, waiting periods, exclusions, benefit limits and other terms may apply. Your previous medical history can also be relevant when determining whether a particular claim falls within your cover.
This is why it’s important to provide accurate information when requested and understand the terms of your policy when you join.
What counts as medical history?
Your medical history can include more than major operations or serious illnesses.
It may include previous diagnoses, hospital admissions, ongoing conditions, treatments, medication or medical procedures you have had in the past.
Even if a condition is currently under control or you haven’t needed treatment for some time, it may still form part of your medical history.
If you’re ever unsure whether information is relevant, it’s better to ask.
What about existing medical conditions?
Having an existing or previous medical condition doesn’t automatically mean Gap Cover isn’t for you.
What it can mean is that certain terms or waiting periods may apply to claims relating to that condition.
This is particularly important if you already know that you may need medical treatment or a procedure.
Taking out Gap Cover shortly before planned treatment doesn’t necessarily mean the associated costs will be covered. Your claim will still be assessed according to your policy terms and any applicable waiting periods.
Understanding Gap Cover waiting periods
A waiting period is a set amount of time after your policy starts during which certain benefits or claims may not yet be covered.
Waiting periods help ensure that insurance is there for future eligible events rather than only being taken out when someone already knows they have an upcoming medical expense.
The waiting periods that apply can differ depending on the policy and circumstances, so it’s important to check your own policy documents.
Don’t assume you’re covered for everything from day one.
Understand what exclusions and waiting periods are.
Your medical scheme still comes first
One of the most important things to remember about Gap Cover is that it works alongside your medical scheme. It isn’t a replacement for medical scheme cover.
When you receive eligible treatment, your medical scheme generally processes the relevant medical accounts first.
There may then be a difference between what the medical scheme pays and what the healthcare provider charges. Depending on your Gap Cover policy and the circumstances of the claim, certain eligible shortfalls or co-payments may be covered.
This is why understanding both your medical scheme and your Gap Cover matters.
Planning a procedure? Check your cover first
If you know you’re going into hospital or having a procedure, don’t wait until the bill arrives to find out how your cover works.
Before treatment, check:
- What your medical scheme will cover
- Whether your medical scheme requires pre-authorisation
- Whether you may have a co-payment
- Whether your healthcare provider charges above the medical scheme rate
- Whether your Gap Cover benefit applies
- Whether any waiting periods or exclusions apply
- What benefit limits apply to your policy
If anything isn’t clear, ask before your procedure.
It can save you from unexpected costs later.
What happens when you claim?
Having Gap Cover doesn’t mean every difference between a medical bill and what your medical scheme pays will automatically be covered.
Your claim will be assessed according to the benefits, limits and terms of your policy.
Your medical history may be relevant to this assessment, particularly where waiting periods or existing medical conditions are concerned.
This is another reason why understanding your policy from the beginning is so important.
Discover the Oneplan Gap Cver claims process.
Know your cover before you need it
Insurance is much easier to navigate when you know what to expect.
Take some time to understand your Gap Cover, including your benefits, waiting periods, exclusions and limits. If you have questions about how your medical history could affect your cover, ask before you need to claim.
At Oneplan, we believe insurance should be simple to understand.
Knowing how your medical scheme and Gap Cover work together can help you make more informed decisions about your cover and avoid unnecessary surprises when medical bills arrive.
Because the best time to understand your Gap Cover is before you need to use it.
Your Gap Cover Family,