Gap Cover
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Do you have all the cover you need?
Are you sure your medical scheme will cover all your doctor and specialist expenses in full should you need to spend time in hospital?
It is a reality that many doctors and specialists charge rates in excess of those covered by the majority of medical schemes, which means that you will have to fit the bill for the difference between what they charge and your medical scheme covers. This could vary from several hundred to several thousand rand depending on the case in question.
Gap Cover is a short-term insurance stated benefit product that covers the difference between your Medical Scheme Rate and private rates charged by a Registered Medical Professionals for in-hospital treatment. Gap cover will settle up to a total of 500% of your Medical Aid Rate depending on your option.
With medical expenses on the rise, can you really afford to be faced with these unexpected costs? Get Gap Cover today.
Options
There are two options available on the Gap Cover Policy:
Gap Cover for Groups
R75-00 – For groups larger than 50 members
R65-00 – For groups larger than 100 members
Will settle up to a total of 300% of your Medical Scheme Rate.
No annual limit / No Excess payable.
Gap Cover 500
R100-00 – For a family of 5 members
Will settle up to a total of 500% of your Medical Scheme Rate.
No annual limit / No Excess payable.
Example
Under a basic Medical Aid Rate, a tonsillectomy should cost approximately *R530. Many doctors would charge in the vicinity of R2 000 or more. This would mean that you would have to settle the difference of R1470.
However if you are insured under a Gap policy, up to 300% of the Medical Aid Rate (300% of R530 = R1 590) could be paid out as a stated benefit to you. Hence in this example, the insured who owes R1 470 would be covered in full.
It is important to note that this product is specifically designed for private tariffs charged by practitioners such as anaesthetists, radiologists, physiotherapists, and specialist surgeons, for in-patient treatment. This product will not cover the cost of hospitalisation.
*These rates are illustrative only.
Waiting Periods for Gap Cover for Groups
No standard 3-month waiting period will apply, pre-existing conditions may be excluded depending on the overall health status of the group.
Waiting Periods for Gap Cover 500
Standard 3-month waiting period is applicable from date of inception, and pre-existing conditions may be excluded for a minimum period of 12 months.
Important Information
• Every application is subject to underwriting
• No maximum entry age
• First 100% of the Medical Aid Rate is not covered by Gap Cover even if this is not paid by your Medical Aid
• Preferential terms for groups
• Terms and Conditions apply
For more information contact Profcon on 049 8922887 / 084 706 9494 or email : profcon.medical@gmail.com
Gap Cover Claim & Application Process