How Much Is Gap Cover Per Month?

How Much Is Gap Cover Per Month?

South Africa boasts a robust private healthcare system, but even with medical aid, unexpected costs can arise. Medical gap cover is designed to bridge the difference between what your medical aid pays and what specialists charge, offering crucial financial protection. But how much does this invaluable safety net cost?

Understanding the Need for Medical Gap Cover

Before delving into the pricing, it's essential to understand why many South Africans opt for gap cover. Medical specialists often charge rates exceeding medical aid tariffs. This difference, known as the "gap," can leave you with significant out-of-pocket expenses. Gap cover steps in to cover this shortfall, typically up to a certain percentage (e.g., 500% or 600%) of the medical aid rate.

Factors Influencing the Cost of Medical Gap Cover

Several factors contribute to the price of medical gap cover:

• Level of Coverage: The extent of coverage offered is a primary driver of cost. Plans with higher coverage limits (e.g., covering up to 600% of medical aid rates) and more comprehensive benefits typically have higher premiums.
• Age: Similar to medical aid, age plays a role. Older individuals often face higher premiums due to an increased likelihood of needing medical care.
• Medical Aid Plan: The type of medical aid plan you have can influence the gap cover premium. Some gap cover providers offer different pricing tiers based on the level of cover provided by your medical aid. Plans with lower day-to-day benefits might lead to slightly higher gap cover premiums.
• Family Size: Gap cover is typically offered as a family plan, covering the main member, their spouse, and dependent children. The number of individuals covered directly impacts the monthly premium.
• Specific Benefits Included: Some gap cover policies include additional benefits like co-payment cover, oncology benefits, or sub-limit extensions. These extra features naturally increase the price.
• Provider: Different gap cover providers have varying pricing structures and risk assessments. It's essential to compare quotes from multiple providers to find the most competitive rate.

Average Cost of Medical Gap Cover in South Africa

While the exact cost varies based on the factors mentioned above, here's a general overview of the average monthly premiums you can expect to pay for medical gap cover in South Africa (as of late 2023/early 2024):

Note: These are just average estimates. To get an accurate quote, it is highly advised to contact various gap cover providers directly.

What to Consider When Choosing Gap Cover

Beyond the price, consider these factors when selecting a gap cover policy:

• Coverage Limits: Ensure the policy covers a sufficient percentage of the medical aid rate to provide adequate protection.
• Exclusions: Understand what the policy doesn't cover. Common exclusions include cosmetic procedures, intentional self-inflicted injuries, and certain waiting periods.
• Co-payment Cover: Determine if the policy covers co-payments required by your medical aid.
• Oncology Benefits: If you have a family history of cancer, consider a policy with enhanced oncology benefits.
• Waiting Periods: Be aware of any waiting periods before you can claim.
• Financial Stability of the Provider: Choose a reputable and financially stable gap cover provider.

Where to Get Quotes and Apply for Medical Gap Cover

You can obtain quotes from:

• Directly from Gap Cover Providers: Many gap cover providers have websites where you can request a quote online.
• Through Financial Advisors: Independent financial advisors can provide tailored advice and compare quotes from multiple providers on your behalf.
• Through Your Medical Aid: Some medical aids offer gap cover as an add-on to their existing plans.

Making an Informed Decision

Choosing the right medical gap cover requires careful consideration. By understanding the factors influencing the cost and comparing quotes from multiple providers, you can find a plan that fits your budget and provides the financial protection you need. Don't hesitate to seek advice from a financial advisor to ensure you make the best choice for your individual circumstances.

Frequently Asked Questions

• Is gap cover the same as medical aid?

No. Medical aid covers a portion of your medical expenses, while gap cover covers the difference between what your medical aid pays and what healthcare providers charge (within the policy's limits).

• Can I have gap cover without medical aid?

No. Gap cover is designed to supplement medical aid and cannot be purchased as a standalone product. You must be a member of a registered medical aid scheme to qualify for gap cover.

• When is the best time to get gap cover?

The best time to get gap cover is as soon as you join a medical aid. This ensures you're protected from unexpected medical expenses from the outset.

• Are there waiting periods for gap cover?

Yes, most gap cover policies have waiting periods, typically around 3 months for general claims and 12 months for pre-existing conditions.

• What if I change medical aid?

You'll need to inform your gap cover provider if you change medical aid. Your gap cover policy may need to be adjusted accordingly. It's best to discuss this with your provider to ensure continuous coverage.