Medical aid is an important part of protecting your health, but many South Africans are surprised to discover that it doesn’t always cover the full cost of medical treatment. That’s where gap cover comes in.
So, what is gap cover? If you’ve ever asked yourself this question or wondered how it works and whether it’s worth having, you’re in the right place. Here’s everything you need to know about how gap cover can help protect you from unexpected medical expenses.
What Is Gap Cover?
Gap cover is additional insurance that works alongside your medical aid to help pay for medical expenses your medical aid doesn’t fully cover.
It is designed to reduce or eliminate the financial gap between what healthcare providers charge and what your medical aid scheme pays. This means you may have less to pay from your own pocket when unexpected medical costs arise.
It’s important to remember that gap cover is not a replacement for medical aid. Instead, it complements your existing medical aid by providing extra financial protection when you need it most.
Why Does it Exist?
Many specialists, surgeons and healthcare professionals charge more than the rate paid by medical aid schemes.
For example, your medical aid may only pay a specialist at a certain tariff, while the specialist charges considerably more. Without gap cover, you could be responsible for paying the difference yourself.
Medical expenses can also include co-payments, deductibles and other costs that aren’t fully covered by your medical aid.
Gap cover helps reduce these unexpected expenses, making healthcare more affordable during what can already be a stressful time.
How Does it Work?
Now that we’ve answered the question: what is gap cover, it’s important to understand how it works.
When you’re admitted to hospital or receive qualifying medical treatment, your medical aid first processes and pays its portion of the claim.
If there’s an approved shortfall or qualifying co-payment, your gap cover policy can then contribute towards those remaining costs, subject to your policy’s terms, conditions and annual limits.
This means you’re not left carrying the full financial burden when medical costs exceed your medical aid benefits.
Learn more about how gap cover can help prevent medical shortfalls.
What Can it Help Cover?
While benefits differ between providers and plans, gap cover can typically help with:
- In-hospital specialist shortfalls
- Co-payments required by your medical aid
- Certain deductibles
- Qualifying day procedures
- Selected scans and scopes
- Additional healthcare benefits included in your policy
Always review your policy documents to understand exactly what is covered and what exclusions or waiting periods apply.
Who Should Consider Gap Cover?
Gap cover can benefit anyone who already has medical aid but wants greater financial protection against unexpected healthcare costs.
It may be particularly valuable if you:
- Want extra protection against specialist shortfalls
- Are concerned about unexpected hospital bills
- Have a family that relies on private healthcare
- Want greater peace of mind when planning for medical expenses
Even comprehensive medical aid options can leave members responsible for certain costs, making gap cover a valuable addition.
What Makes Oneplan Gap Cover Different?
Oneplan Gap Cover is designed to help South Africans manage the unexpected costs that medical aid doesn’t always cover. If you’re still asking, “What is gap cover?”, Oneplan Gap Cover provides a practical answer by helping cover qualifying medical shortfalls and co-payments.
Depending on the option you choose, benefits can include:
- Cover for in-hospital medical shortfalls and co-payments
- No sub-limits across benefits
- Day-to-day savings benefits
- Cancer cover
- Mental health benefits
- Accidental HIV testing and treatment benefits
- Accidental death benefits
With affordable monthly premiums and practical benefits, Oneplan Gap Cover helps provide additional financial protection when you need medical treatment.
Watch our Gap Cover plan option videos.
Is Gap Cover Worth It?
Medical emergencies are stressful enough without worrying about unexpected bills.
While no one plans to need surgery or specialist treatment, having gap cover can help reduce the financial impact when healthcare costs exceed what your medical aid pays.
If you already have medical aid and want extra protection against medical shortfalls, gap cover can offer valuable peace of mind and help you prepare for the unexpected.
Discover our Gap Cover plan options.
Protect Yourself Against Medical Shortfalls
Medical aid is an essential first step, but it doesn’t always pay every medical bill in full. Gap cover helps bridge the difference, giving you greater confidence when unexpected healthcare costs arise.
Get your Oneplan Gap Cover quote and discover how you can better protect yourself and your family from unexpected medical expenses.