The Importance Of Top-Up/Gap Cover
By Rudolph Ackermann, CEO at MANAGE ALL
Top-up/gap cover can play an important role in your overall healthcare portfolio as it provides an additional layer of protection against high-cost, unforeseeable medical expenses that would otherwise be difficult to afford.
Did You Know – You Do Not Need To Use The Same Provider As Your Medical Scheme Plan
You can choose a universal top-up/gap cover policy to link to your medical scheme plan. The policy therefore need not be from the same provider as your medical scheme plan, as not all medical schemes offer their own top-up/gap cover.
What Is Top-Up/Gap Cover?
In its simplest form, top-up/gap cover is supplementary insurance that helps medical aid members bridge the financial gap between what is charged by medical professionals in hospital and the amount reimbursed by the medical aid. Service providers can charge way in excess of the medical aid tariff and the difference – i.e., the gap – can be unaffordable for the average person. As such, top-up/gap cover is designed to provide financial protection against such unexpected medical costs.
Is Top-Up/Gap Cover An Insurance Or Medical Aid Benefit?
Whereas medical aids are regulated by the Medical Schemes Act, top-up/gap cover is a loose standing short-term (non-life) insurance product which, together with your medical aid, provides top-up health cover up to certain limits. By design, its role is to provide additional financial protection to medical scheme members who receive in-hospital treatment and care so that they are not saddled with large out-of-pocket expenses following a hospital event.
How Much Does Gap Cover Pay Out?
The cover provided by your gap cover benefit will depend on the level of cover you opt for, which can range from 200% to 600% of the medical aid tariff.
Example:
A medical procedure may cost R200 000.00, and your medical scheme covers only R120 000.00 of the cost. Without top-up/gap cover you will be personally liable for R80 000.00 to the provider. As a top-up healthcare benefit, your top-up/gap cover should not be viewed in isolation but rather as part of your overall medical risk portfolio.
Important:
Manage All offers a unique range of top-up/gap cover policies through Cura Administrators, also an authorised financial services provider. Cura policies are universal policies that will compliment any medical scheme or hospital plan you may have, as not all medical schemes offer a top-up/gap cover product.
Because of the varying number and types of gap cover policies available, it is often difficult to do a comparative benefit and premium analysis, and it may be worth your while seeking advice from an independent and professional MANAGE ALL Advisor who can guide you through the process.
You can view the unique Cura range of top-up/gap cover policies at the following secure link: https://www.curaadmin.co.za/gap-cover/ or call the MANAGE ALL or CURA ADMINISTRATORS office at 010 021 0250.
