we understand that the best healthcare practices are complex and overwhelming to comprehend. This is why we make client education our focus.
We often find that members are only made aware of the shortfalls and risks within an option when uncontrollable healthcare events occur. We enable our clients to understand all the relevant benefits that a medical scheme can offer, including shortfalls.
We have contracts with numerous medical schemes allowing us to guide, educate and protect our clients, providing the right advice for you to make an informed decision.
Did you know that service providers are entitled to charge more than the medical scheme rate? Some hospital and comprehensive medical plans offer cover at 100%, 150% or 200% of medical scheme rates for hospitalisation only, while the actual costs could be up to 500% of medical scheme rates.
Many medical aid members do not consider that there is often a shortfall between what a medical scheme will pay and the actual cost of an in-hospital procedure or treatment. The shortfall would become your responsibility which is where gap cover fits in.
A gap cover policy will cover the difference between what your medical scheme will cover and the actual cost of your in-hospital doctor’s bills up to a maximum of 500% of medical scheme rates.