Bonitas Member Magazine B-Living Issue 2_2019 | Page 17

Gap cover is an insurance policy that covers you for the difference between what your medical aid pays and what is charged by a registered medical professional for in-hospital treatment (this differs depending on the type of policy and product). At times, there may be a shortfall between what your medical aid is willing to pay and the rate the hospital or specialist is charging. You will then be responsible for paying the difference. That is where gap cover comes in. Who should have gap cover? It is only available to someone who has a medical aid plan. Taking out gap cover is an individual choice based on a range of factors, centred on personal needs and the benefits of a medical aid plan. Choose MedGap, gap cover Underwritten by Guardrisk Insurance, MedGap offers Bonitas members easy to understand and affordable products. Our products are specially designed to provide cover for medical expense shortfalls in the event of hospitalisation involving surgery or medical treatment, as well as for certain procedures performed out-of- hospital. Gap cover supplements your medical aid It is important to know that gap cover is an insurance policy and is regulated under the Long and Short Term Insurance Act (1998). Medical Schemes, on the other hand, are overseen by the Council for Medical Schemes Act (1998) and are not ‘insurance’. Gap cover differs from policy to policy in terms of the percentage payout as well as any waiting periods or exclusions regarding treatment. Even if you have a top of the range medical aid plan, it doesn’t mean there will not be ‘gaps’ between the tariffs your scheme is prepared to pay and the amount your specialist charges. Most people take gap cover together with a medical aid or hospital plan. Recently, as part of the Demarcations Act, there have been changes made to gap cover policies such as maximum payouts per annum, etc. Why you should have gap cover You can choose cover from the Medgap Primary and Supreme options. How are claims settled by MedGap? At MedGap, we strive to make claiming easy for our clients. If you have given consent for claims data sharing with Guardrisk Insurance company, the claim will be automatically processed and paid to the member. To submit the claim manually, you have four months from the date of treatment to provide us with written notice of your claim and send it to [email protected]. Get gap cover today with MedGap To get gap cover from Medgap, you can call us on 0860 102 936, SMS "Medgap" to 43366 or alternatively visit our website www.medgap.co.za and leave your contact details so that one of our accredited consultants can contact you. The advantage of having gap cover is being insured against some of the additional costs that could be incurred with an in-hospital procedure, in that it will help lessen, or cover, the shortfall between the rates paid by your Medical Scheme and the actual charges by the hospital or specialist. You should never assume that all costs will be covered as the payment options depend on the product you have taken out which is subject to limits and exclusions. The onus is on you, the policyholder to check what is covered, what is excluded and how much will be paid. Page 16