Another potential out-of-pocket expense for medical scheme members is co-payments for in- and out-of-hospital procedures. This co-payment is an excess amount imposed and specified by the medical scheme.
Owners of a CoPay Cover policy, also a short-term insurance product, enjoy cover for co-payments on procedures performed as in- and out-patients, hospital admission fees, and for co-payments charged on MRIs, CTs and ultrasound scans.
Including additional cover up to R12 000 co-payment for the use of a non-DSP (Designated Service Provider) Hospital, limited to 1 event per calendar year, per policy.
Who qualifies for CoPay Cover?
- Most open medical schemes in South Africa impose co-payments on certain procedures, for instance scopes and specialised radiology. So, members of these schemes could all benefit from cover against these co-payments.
- As with GapCover®, one CoPay Cover policy will provide benefits to the principal member, the spouse or life partner and biological or legally adopted children that are registered as such on his/her medical scheme certificate.
- To ensure cover, please ensure that your dependants are registered on the CoPay Cover policy as well.
How and when will CoPay Cover apply?
- A CoPay Cover claim will be paid when your medical scheme charged a co-payment for an in- or out-of-hospital procedure (which includes an MRI, CT or ultrasound).
- There is a R12 000 limit per event
- A co-payment claim does not cover penalties that resulted in the member not following scheme rules
- CoPay Cover is subject to underwriting and exclusions as per the policy contract
What does it cost?
- CoPay Cover is available at R70 per month per family (R12 000 limit per event)
- There is also GapCover® available at only R160 per family, per month
- Or, get GapCover® and CoPay combined at only R215 per family, per month
(if you’re part of an employer group, click HERE)