The Council for Medical Schemes recommends an annual medical aid rate – this is the base rate that can be charged by all medical practitioners for medical procedures. Most medical aids agree to pay up to a certain percentage of this rate – in most cases up to 300% of this rate. However, medical practitioners are free to charge whatever they want for their services, and should your provider charge more, it will be your responsibility to cover the shortfall.
For example: Let’s say your medical aid covers up to 300% of the medical aid rate. If a medical practitioner charges 500% of medical aid rates, your medical aid will cover the first 300% and you will have to pay the additional 200%. Medical practitioners may also request certain tests and procedures which would also require co-payments from your pocket.
Medical procedures are expensive, and this can mean an instant bill of tens of thousands of Rands, if not more. Gap Cover is important, additional insurance you buy in conjunction with your medical aid to cover this shortfall.
Old Mutual Gap Cover 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.
Old Mutual Gap Cover offers excellent In-Hospital, In- and Out-of-Hospital Oncology and Out-of-Hospital benefits to cover defined medical expense shortfalls for tariffs, oncology, sub-limits, co-payments and deductibles, plus a Benefit Extender in addition to the core benefits.
The total maximum Compensation Limit payable for all Core Benefits and Benefit Extender will be limited to R174 000 (one hundred and seventy-four thousand rand) per family member, per annum.
* Cover benefits, limits and maximum compensation limit applicable from 1 January 2022.
Terms & Conditions apply.
IMPORTANT TO NOTE:
Please note the 3 months general waiting period, 12 months pre-existing condition waiting period and 12 months pregnancy waiting period apply to an insured person from the time that such person's cover commences under the policy (to run concurrently if two or more waiting periods are applicable to an insured family member).