Private providers are now charging up to 5 times the basic medical aid rate your plan may pay!
So, healthcare Plans now offer - more expensive plans - that pay at 2 or 3 times the medical aid rate.
But that is still not enough and the possible gap you could be liable for can no longer be ignored.
Unfortunately, South Africa is a violent country and the threat of you being hospitalised is very real.
Do not think, because you have medical aid you will not face a financial threat of short paid hospital costs - you can!
You really need to cover possible in-hospital shortfalls and copayments that you may have to pay on certain procedures.
You may have substantial shortfalls to pay!
And this is the case with almost all Medical Aid plans.
Do you even know at what rate your scheme pays in-hospital specialists? Don't think twice - join today!
If you are a medical aid member, you need a Gap or Top Up plan.
Don't think twice - join today!
That is known as the scheme (medical aid) rate. Schemes then pay at that rate.
If you use private providers, they can charge what they want - known as the private rate.
This can be 5 times more expensive than the medical aid rate!
Medical aids now offer more expensive plans, that will pay up to 3 times their scheme rate, to help you with that claim shortfall. (Generally, hospital and ward fees are charged at the scheme rate and are fully covered.) But these rates of payment are not sufficient to prevent a potential claim shortfall.
Here are 4 common hospital procedures, including specialist and anaesthetist fees.
You can clearly see the potential payment you would have if you are on a plan that pays medical aid rates in-hospital.
You also face financial threats of copayments for certain procedures. More expensive plans have fewer copayments.
Let's look at an example...
You need a hip replacement. Most medical aids pay ward and theatre fees in full, as these are billed at medical aid rates.
But specialist and other private providers can - and do - charge above this rate.
These specialists charge R 25,300.
Your medical aid pays R 8,423 of these costs.
You have to pay R 16,877! That's not going to help your recovery!
You have 2 options to address this threat.
1. You can use network providers who are linked to your medical aid because, they will charge what the plan pays. So, you should never experience an in-hospital claim shortfall.
Yes, your Top Up will make good on any shortfalls or copayments you have, up to a legislated maximum of R 157,000 per family, per year.
Every medical scheme member should have an insurance-based Top up plan. It is a vital part of having a full in-hospitalbenefit, healthcare plan!
These are totally separate products to medical aid and will work with any medical aid.
Also,, that if your medical aid would never have paid for a claim - in terms of their rules - neither will the Gap plan.
These are amounts that need to be paid to the hospital/day clinic/radiologist before undergoing certain procedures.
Again, more expensive plans have fewer copayments.
You pay a portion of the costs for procedures and your medical aid pays the rest. This is your copayment.
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Note: Benefits are plan dependent.
It is important to note that this product is specifically designed to help you meet the private tariffs charged by doctors, anaesthetists, radiologists, physiotherapists and specialist surgeons, for in-patient treatment.
It does not cover the actual cost of the hospitalisation.
A standard 3 month waiting period is applicable from the date of inception to policy, and pre-existing conditions may be excluded for a minimum 12 months.
There is a total exclusion for any pre-diagnosed cancer and 12-month maternity exclusion. Terms and conditions do apply.
With this cover, YOU will NEVER fear the pressure of financial shortfalls in the unfortunate event of hospitalisation.
You owe it to yourself and your family to investigate these Top Up and Gap Cover Cover policies!
You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.