You’ve been looking into a medical aid gap cover policy, but at the moment you still need to finalize getting onto a medical aid scheme. Your question is simply this,”Can I take out a medical aid gap cover policy without belonging to a medical aid scheme?” It’s a fair question, so let’s find out..
The answer unfortunately is No. In order to qualify for a medical aid gap cover policy, you first need to become a member of a medical aid scheme. And the scheme you intend joining needs to be a Medical Scheme registered with the Registrar of Medical Schemes in terms of the Medical Schemes Act No 131 of 1998.
It’s a bit of a mouthful but here it is in simple terms.
The whole idea around medical aid gap cover is to provide you with additional coverage when your medical aid scheme doesn’t pick up certain claims in full.
Healthcare specialists in South Africa are charging what they like for their services, and medical aid schemes aren’t prepared to pay these exorbitant bills in full.
Can you see a problem emerging?
A gap between what healthcare specialists are charging and what schemes are prepared to pay is getting wider and wider. Hence the name “medical aid gap cover” – An insurance policy specifically designed to cover the gap in your healthcare cover.
Ok Brendan, I get why I need medical aid gap cover but why can’t I qualify for a policy if I don’t belong to a medical aid scheme?
Simple, if you don’t belong to a medical aid scheme, you can’t claim your medical expenses. And if you can’t claim your medical expenses in the first place, having a policy that covers shortfalls in medical aid claim payments is about as useful as having motor insurance when you don’t even own a car.
But what if I’ve got one of those medical insurance plans? You know the type that pays out a specific Rand amount when I land up in hospital. Can a medical aid gap cover policy cover the shortfalls in this cover?
Nope that type of healthcare insurance plan doesn’t qualify either. You need to belong to a registered Medical Scheme. Currently there are around 110 registered Medical Schemes in South Africa which are governed by the Medical Schemes Act and watched over closely by the Council For Medical Schemes.
If you are unsure whether your private healthcare partner falls under the definition “Medical Scheme” visit the link I’ve provided at the end of this blog post or give them a call and clarify.
One last question Brendan, “Is the medical aid gap cover policy restricted to any specific medical aid scheme?” Nope it doesn’t matter what medical aid scheme you belong to, medical aid gap cover can piggy back on any South African medical aid scheme and plan type.
PS: Here is the link to the Council for Medical Schemes.
InsuranceFundi has partnered with some of SA’s most reputable insurance and investment companies. We believe that everyone should have access to a wide range of comprehensive and affordable solutions. Pick the product you are interested in below, and expect a call-back from our partners.
Until next time.
The InsuranceFundi Team