For Patients

GAP COVER

What is Gap Cover?
Gap Cover provides a benefit equal to actual cost limited to 4 times the medical scheme rate less the payment for treatment received for services rendered by doctors and/or specialists while hospitalized as an inpatient.

The National Health Reference Price List (NHRPL) is a pricing system maintained by the Department of Health and the Council for Medical Schemes. The NHRPL specifies the rates to which your medical aid scheme must adhere. It is the amount of money that they are bound by law to pay out for a given situation. Doctors, hospitals and other medical service providers however, are not bound to these rates, and in fact charge up to 300% above these NHRPL prices. So despite thinking you are financially covered for any medical eventuality in its entirety, for the most part you are not, and are often liable for an enormous shortfall.

Who can apply for GAP cover?
Gap Cover can be obtained by individuals that is currently on a medical scheme and is 65 years of age and younger.

Most medical schemes can offer Gap Cover and the internet provides information on the different companies offering Gap Cover.

Here is a few links:

http://www.optivest.co.za/

http://www.coverthegap.co.za/