Gap Cover: The Cost of Delay

May 31, 2018

You’ve heard the term “the cost of delay” when referring to investment or retirement planning, but there is another financial planning scenario where this term is also most appropriate – Health planning.

Gap cover is a short-term insurance policy that serves as protection against potential financial shortfalls created by the difference in what a medical scheme will pay for an in-hospital procedure versus what your specialist will charge. Not only do you have to worry about the specialist charging way beyond what your medical scheme will pay, but the hospital may also charge a co-payment or deductible when undergoing a particular procedure. Just the thought of these two scenarios coupled together with the potential for a shortfall when being diagnosed with cancer is enough to send anybody into hospital!

Oncology treatment is expensive and depending on what stage of cancer you’ve been diagnosed with, the treatment plan your oncologist is using and the length of time it takes for your treatment to be effective could place a significant financial burden on you. Medical schemes have limitations on the level of oncology benefits they provide. Once you’ve reached that limit most schemes will apply a co-payment for any further treatment you receive during the year. This in most cases is as much as 20% of the cost of any further treatment.

“So what has the cost of delay got to do with any of this?” I hear you say. Well, quite a lot really. You see, a short-term insurance policy that provides cover for these potential shortfalls comes with waiting periods. The insurer, in order to protect their risk pool from any potential anti-selection, will impose certain waiting periods that will apply from the date of commencement of your policy. This means that you can’t claim against the policy for a specific condition while in a waiting period. Some waiting periods are for 3 months while others could be as long as 12 months. Experience has shown that a lot of clients only decide to take out a gap cover policy when they realise that their upcoming in-hospital procedure will create a financial shortfall for them. This is too late! Like any other form of insurance, you elect to insure yourself or your worldly possessions against the possibility of an incident occurring sometime in the future. You don’t take out insurance on the contents of your home knowing that you’re about to have a burglary! And if you do, that would be a serious case of anti-selection and you may well find yourself in trouble with the insurer.

So why delay? Decide today to take out that gap cover policy and avoid any disappointment in the future. The sooner you initiate your policy the more likely you are to be outside any waiting periods when needing to claim.

CompliMed Gap Cover ensures that you and your loved ones are covered as much as possible through our comprehensive, simple and affordable Gap Cover solutions.

Treatment date of the claims is within:	Benefits for childbirth will be capped at:
First 12 months of the Policy	R8 000 per event
13-24 months of the Policy	R12 000 per event
25+ months of the Policy	Subject to the Overall Annual Limit of the Policy

Medical Service Provider	Amount Charged by Medical Service Provider	Amount Paid by Medical Scheme	Amount Paid by CompliMed®
Surgeon	R17,053	R6,021	R11,032
Anaesthetist	R8,256	R2,402	R5,854
		Total Paid by CompliMed®	R16,886