Gap cover is temporary insurance that fills the funding gap between your medical aid and the actual cost of medical care.
Get some relief from the stress of worrying about medical bills, specialists’ fees, and other hidden costs like scans and counselling by purchasing gap cover.
This article compares and summarises the top gap cover plans and their associated costs in South Africa for 2023.
1. Zestlife Universal Gap Cover
Zestlife Universal Gap Cover is an economical option that offers extensive coverage for unexpected medical expenses. The maximum amount of compensation per covered person per year is R182,700.
General practitioner (GP) and specialist (specialist) consultations outside of the hospital are reimbursed at up to 500% of the medical insurance tariff. The daily perk is good for more than 50 sessions of care.
In the event of a medical emergency, patients will not be responsible for any out-of-pocket costs. This includes enhanced cancer coverage, copayment coverage for CT, MRI, and PET scans and hospital admissions, and a non-network copayment benefit.
Coverage for in-hospital dental care and robotic medical treatments are also included in the Universal benefit package, in addition to the standard coverage for emergency rooms.
Exclusions are restricted and waiting periods are not imposed at will. Policyholders of Zestlife can choose to renew their cancer coverage at any time.
2. Sirago Gap-Lite Cover
Sirago’s Gap-Lite Cover is made with the modern family in mind. Shortfalls in medical aid are compensated up to R183,000 per year, or 250% of the scheme rate.
Hospital stays, imaging, surgical procedures, and the utilisation of non-preferred physicians are eligible for limited co-payment coverage. Treatments for PMBs at non-DSPs and procedures performed in day hospitals or doctors’ offices are covered to a minimal extent.
Coverage for things like trips to the ER and routine check-ups are there, as are perks for new parents and infants.
3. Stratum Compact 300
Stratum Compact 300 is a family-friendly and reasonably priced choice. Standard medical treatment up to R177,838 per year is covered.
Up to 300% of the medical scheme fee is reimbursed in the event of a shortfall for in-hospital operations. Scopes, scans, radiography, pathology, physiotherapy, medicine, and some dental procedures are all included in the benefit.
4. Liberty Universal Gap
Liberty Universal Gap provides comprehensive gap coverage for outpatient care and hospital-based treatments. Payments will be made at a rate of 500% of the medical programme rate, up to an annual maximum of R182,700 per person.
There is a non-network benefit included in the extensive co-payment coverage. Beneficial coverage for cancer treatment, internal prostheses, artificial joints, and in-hospital dental care are included, as well as accidental death and permanent disability protection.
5. Discovery Health Gap Cover
All members of Discovery Health have access to gap insurance. The monthly premiums paid by members are determined by the specific medical aid plan they are enrolled in at any given time. Those who aren’t already enrolled in Discovery Health aren’t eligible for coverage.
Image Courtesy: Supplied