11/11/2017
The coverage provided by your medical aid can sometimes be a minefield to navigate. A lot of medical aid members are unsure about the exact coverage provided when they are admitted to hospital.
What you need to know is that your hospital account consists of two components:
1. Your hospital bill (bed, theater, etc.)
2. Related accounts, i.e. doctors and specialists who treat you in hospital.
Your hospital bill will normally be covered in full by your medical aid, with a few exceptions.
The related accounts are where the trouble is... Doctors and specialists either have a payment arrangement with medical aids, or they don't. Where they do not have a payment arrangement with medical aids, they are free to charge you an amount much higher than medical aid rates. That is where your bill problems begin... Depending on your length of stay in hospital, you are potentially exposed to massive shortfall payments by your medical aid.
In response to this, the insurance industry has responded with a product called medical gap cover. There are products with different levels of coverage offered by various insurers. In essence, the core of all gap cover products is to cover you for the exposure to related accounts, as mentioned above. So how do you make your decision on which gap cover product to invest in?
You consider the following:
- The reputation and solvency of the product provider;
- The ancillary benefits offered, which could include co-payment cover, cancer cover, premium waivers, out-patient visits to specialists, etc.;
- The premium comparison between the different product providers; and
- Whether there is an established brokerage which can advise and assist you with claims.
Contact us today at [email protected] or Facebook Messenger for professional advice on medical gap cover.
