Medical Aid & Gap Cover: Why Pay More For Less in 2019?

Medical Aid is pricey, right? The world is feeling the financial pinch at the moment with emerging economies like our own here in South Africa, feeling it more than most. The current cost of living is increasing at a rate that our income cannot keep pace with. It seems we now have to pay more for less in every aspect of our daily lives. Something has to give. We have to cut back on our spending. Find ways to reduce our monthly expenses. Buy a cheaper house. Drive a smaller car. Downgrade our medical aid option. Cancel our gap cover policy…

There are some essentials, no, absolute necessities, which we cannot afford to do without at present, and that is being covered by a registered medical aid plan and investing in a gap cover policy. Our Minister of Health is adamant that his NHI scheme is the answer to providing better health care for all, even though it’s common knowledge that our public hospitals have been failing its people dismally for many years now. Until such time as NHI is fully implemented and we’re all obligated to contribute to the fund, private healthcare is still the only option, if you’re fortunate enough to be able to afford it, that is.

However, this doesn’t mean that you shouldn’t “shop around for the best deals.” The medical aid industry is still a very competitive business, with most schemes being able to offer a range of different plans that may suit your needs better than the next. You may want to consider downgrading your current option in order to save on premium, but you must consider what you will lose in benefits. The cheaper the option the lower your in-hospital cover and the more co-payments may apply. Network plans are another way of reducing the price of your plan, but these plans limit you to a specific hospital network, which may not be suitable for you in terms of where you reside.

The upside of downgrading your medical aid option is that you can pretty much make up for what you’re losing in benefits by taking out a comprehensive gap cover policy. A comprehensive policy will increase your in-hospital procedure cover by as much as 500% and include cover for most co-payments and deductibles. Cancer treatment is another area that is of a major concern to everybody and your gap cover policy will provide additional cover for oncology treatments. Any Co-payments applied for your treatment or where you’ve reached the overall annual scheme limit, an additional cover will be provided to assist you with this shortfall.

Most gap cover providers offer a range of products that vary in premium and benefits. They may add some “bells and whistles” in order to make their offering seem more attractive than their competitors, but in essence, the “nuts and bolts” of each plan is exactly the same. Product providers will try and keep your annual premium increases in check by balancing premium with benefits with waiting periods and exclusions. However, when a product provider’s claims exceed premium for a particular period, this will have an effect on your annual premium increase. These increases over a prolonged period of time could ultimately price your policy out of the market. The result of this is that you could be paying too much for your gap cover policy currently.

Consider shopping around and looking at an alternative product provider. Find a product that can give you more benefits for less premium, or at the very least, the same benefits at a cheaper price. Waiting periods are normally applied to new policies, however, concessions will apply on transfers, should you have been on the cover with your current provider for 12 months or longer.