Medical Aid Gap and Top Up Plan

Best 2019 GAP and TOP UP PLAN.

Pay Medical Aid claim shortfalls and co-payments.

Will Your Medical Aid leave you with a Shortfall or Co-Payment in hospital?

Your medical aid does not guarantee that you won't have to pay money towards your medical costs!
You really need to cover possible in-hospital shortfalls and co-payments that you may have to pay on certain procedures.

And this is the case with almost ALL MEDICAL AID PLANS.
Do you even know at what rate your scheme pays in-hospital specialists?

With this best Gap and Top Up plan you can rest assured knowing there are no more hidden medical expenses for in-hospital treatments and procedures.

What is Top Up Cover?

Medical schemes pay in hospital costs at differing rates. At the beginning of a year all medical providers and medical schemes decide on the cost of a procedure.
That is known as the scheme (medical aid) rate. Schemes then pay at that rate.
If you use private providers, they can charge what they want - known as the private rate.
This can be 5 times more expensive than the medical aid rate!
So, medical aids now offer more expensive plans, that will pay up to 3 times their scheme rate, to help you with that claim shortfall. But it is not emough of a benefit, to prevent a potential claim shortfall.

Let's look at an example...
You need a hip replacement. Most medical aids pay ward and theatre fees in full, as these are billed at medical aid rates.
But specialist and other private providers can - and do - charge above this rate.
These specialists charge R 25,300.
Your medical aid pays R 8,423 of these costs.
You have to pay R 16,877!
That's not going to help your recovery!

What can you do to address this threat?
If you can use providers who are have a payment agreement with a medical scheme, they will charge what the plan pays.
So, you should never experience an in-hospital claim shortfall.

Most medical aids will offer more expensive plans that pay at 200% or 300% of scheme rates.
But that is still short of what you may be charged, because private providers can charge up to 500% of these tarrifs!

Top Up/Gap cover is an insurance product that covers the difference, in hospital, between what your medical aid pays and the actual cost of provider's bills.

It pays up to a maximum of 500% of your medical aid tariff so YOU no longer need to fear having to pay these in-hospital shortfalls!

But, that is not all.

Medical aids are increasingly adding co-payments for certain in and out of hospital procedures.

What is CoPay Cover?

In order to contain costs, medical aids are increasingly imposing co-payments for treatments and procedures, like MRI, CT, ultrasounds, scopes, prosthetics and scans.
These are amounts that need to be paid to the hospital/day clinic/radiologist before undergoing certain procedures.
Again, more expensive plans have fewer co-payments.

You pay a portion of the costs for procedures and your medical aid pays the rest. This is your co-payment.

CoPay will pay your co-payments for procedures performed in-hospital as well as some specified out-patient procedures including MRI, CT and ultrasound scans.

There are many of these plans available and they will cover most medical aid shortfall and co-payments, but this one is the most comprehensive for the price!

Premiums range from R 324 per family, per month for a very valuable plan!








The plan works with any medical aid!
Enhance your cover without having to change from your medical scheme!

Note: Benefits are plan dependent.
It is important to note that this product is specifically designed to help you meet the private tariffs charged by doctors, anaesthetists, radiologists, physiotherapists and specialist surgeons, for in-patient treatment.
It does not cover the actual cost of the hospitalisation.
A standard 3 month waiting period is applicable from date of inception to policy, and pre-existing conditions may be excluded for minimum 12 months.
There is a total exclusion for any pre-diagnosed cancer and 12 month maternity exclusion. Terms and conditions do apply.
With this cover, YOU will NEVER fear the pressure of financial shortfalls in the unfortunate event of hospitalisation.

You owe it to yourself and your family to investigate these Top Up and Gap Cover Cover policies!


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