A global pandemic and nationwide lockdown… who would’ve ever imagined or predicted this in the year 2020? Life, just like accidents, is unpredictable.


Even though you’re home during lockdown doesn’t mean an accident or medical event can’t happen – planned or otherwise.


It’s important to not have a knee-jerk reaction and panic cancel your medical aid and gap cover – if you can help it! The last thing you want is to be faced with unexpected medical bills on the back on an extended lockdown. Rather get advice from your broker about an option change to a more pocket friendly option, as opposed to cancelling because in the long run, these are going to save you money if an emergency hits.  Some cover is better than no cover.


If possible, try cutting expenses where you can and ensure you and your loved ones have cover when it matters most.


The reality is that as much as medical aid plans offer comprehensive and well-structured benefits, it may be limited.


Your medical aid plan covers doctors, specialists, hospital fees and medical services at a specific medical aid rate. Whilst many healthcare providers charge according to the medical aid rate, there are many that don’t. That’s because healthcare providers are free to charge whatever they want for their services. If your provider charges more than what your medical aid pays, you’ll be liable for the shortfall that your medical aid doesn’t cover.


For example: Your medical aid plan covers up to 200% of the medical aid rate. If your healthcare provider charges 400% of medical aid rates, your medical aid will cover 200% and you’ll be liable for 200%.


That’s why gap cover is so important to have. It works with your medical aid plan and complements the cover your medical aid plan provides.


To put things in perspective, here’s a breakdown of a recent back operation claim we covered for a client:


Healthcare Provider Amount Charged Amount Paid by Medical Aid Amount Covered by our Gap Cover Policy
Orthopaedic Surgeon R   82 183.77 R 26 419.87 R 55 763.90
Specialist Anaesthetist R   19 891.31 R   6 658.61 R 13 232.70
Physician R     3 352.43 R   1 544.88 R   1 807.55
Co-Payment imposed by Medical Aid R   10 000.00 R 10 000.00
TOTAL R 115 427.51 R 34 623.36 R 80 804.15


It would take this client more than 20 years to make up in premiums what we paid in claims.


So, if you’re questioning whether Gap Cover is worth it – the answer is YES!