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A medical scheme membership does not mean you will not have extra medical expenses.
In the South African medical landscape, the medical practitioner can charge more for in-hospital procedures than what your medical scheme is willing to pay.
That creates a situation where you as the patient go to hospital for Specialist, Anaesthetist and Radiology services and you are charged up to 500% of medical scheme rate. The difference between the private doctor’s rate and your medical scheme tariff creates an excess amount which you would be charged for in your personal capacity. Read More
*This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
To ensure you are not unpleasantly surprised by out-of-pocket expenses after a hospital procedure, invest in a GapCover® policy.
GapCover® is a short-term insurance product that could cover that medical shortfall amount that occurs when medical service providers charge more than what the medical scheme would pay.
This applies to procedures in a hospital, an unattached operation theatre or day clinic.
The Medical Scheme Rules in South Africa allows your medical scheme to impose co-payments (payments on top of the hospital and medical services charged) which you must pay on certain procedures in- and out-of-hospital. These co-payments could also apply for MRI, CT, PET, SPECT and Ultrasound Scans.
As with the medical shortfall amounts, the co-payments are for your own account.
CoPay Cover is a benefit (available as part of the Combined Cover benefits) which would cover these excess amounts you would have to pay.
Invest in GapCover and prevent any unpleasant out-of-pocket expenses after your hospital procedure. Fill out our online form and one of our consultants will help setup your GapCover policy.