GAP IT Cover offers South Africans a simple, personalised way to get the gap cover medical insurance that they need.

We get it — signing up for medical cover can be confusing! We can all agree that your health is your most valuable asset, but even so, signing up for a medical aid scheme can definitely feel a grudge purchase most of us don’t want to fork out for. And then, to make matters worse, we’re told we may need gap cover too?

At this point you’re probably scratching your head asking why you need additional insurance to cover your medical care scheme — and what’s the difference between a medical aid, medical insurance, and gap cover anyway?

There’s no need to stay in the dark, GAP IT Cover is here to help demystify medical gap cover and everything in between.

Why do I need gap cover if I already have medical aid?

Gap cover and medical aid schemes go together like spaghetti and meatballs. Gap cover is a short-term insurance product designed to provide extra protection for those who already have medical aid. Depending on which plan you have, gap cover will reimburse you for co-payments and shortfalls not covered by your medical aid provider.

For medical aid members forking out a tidy sum every month, the idea of having to take out additional health care insurance can be infuriating. However, one way that medical aid schemes try to keep contributions as affordable as possible for their members is through negotiation with hospital groups (on Hospital Network options), doctors, specialists, and certain other medical service providers for better tariffs. The problem for medical aid members comes when you choose not to use these Designated Service Providers (DSPs), or where a suitable provider is not available either on the network, or where an option with a hospital of choice is not available on a hospital-network option.

If you prefer not to be restricted to a DSP hospital-network, or medical professional who does not have a payment agreement with the medical aid, then you can opt for more comprehensive medical scheme benefit options. However, non-network options, and options that remunerate providers at the private rate, come at a higher contribution.

How do I know which gap cover plan is best for me?

Fortunately, there are a variety of medical gap insurance providers to choose from in South Africa, but the process of finding the right gap cover plan and signing up can be overwhelming.

The snag for many people is that to truly be sure you’re choosing the right gap insurance policy for your needs, you’ll need to be quite familiar with your existing medical aid scheme and what it covers (easier said than done, we know!).

We all read through the contracts when registering for our chosen medical aid scheme (well, we tried at least) but you’d be forgiven for still feeling like you aren’t aware of exactly what your medical aid scheme entails — what you are covered for, and what you aren’t.

Generally speaking, gap cover products can only address medical expense shortfalls for something that has been partially covered by your medical aid. If your medical aid doesn’t cover a certain procedure or specialist bill at all, then your gap cover won’t be able to assist. In other words, to truly have an understanding of what a gap cover policy will offer you, you will need to immerse yourself in the details of your medical aid plan guide, but even this process can be overwhelming.

That’s where GAP IT Cover comes in; it’s gap cover made simple!

Demystifying gap cover

GAP IT Cover offers South Africans an expert voice that can hold your hand through the whole gap cover process. From researching the best plan for your needs based on your current medical aid scheme, to signing up, and even claiming.

GAP IT aims to make the gap cover application process, after-sales service, and claims process as accessible as possible. It may be easy for you to get gap cover online, but there is the risk that it might not be the right gap cover product for your needs, which means you may end up paying too much for a product that doesn’t offer the right cover.

GAP IT takes it back to ‘old school’ methods by being a trusted, honest companion through the entire process of getting the most suitable gap cover for yourself and your family. Forget call centres with a script aimed at signing you up as quickly as possible. With GAP IT you speak to not only a real person, but an expert that takes into account your specific, individual needs and current medical aid scheme to help you find the best gap cover product for you.

Once you’ve decided on a gap cover provider and plan, GAP IT makes sure the paperwork is done efficiently and timeously. This makes getting cover as easy and stress-free as possible for you..

GAP IT also promises a ‘proof is in the pudding’ approach when it comes to clients being covered. When issues occur and you need your gap cover, GAP IT will manage the claims and queries on your behalf. To submit a claim, you simply contact GAP IT, who will ensure a smooth ride in the claims process. Rather than dealing with a call centre when you’re feeling your worst, GAP IT has your back every step of the way to ensure that you can submit a claim as quickly as possible.

It’s this emphasis on old school-style personal service that sets GAP IT apart from the rest of the gap cover products available in South Africa. GAP IT aims to bridge the divide for consumers by combining very personal service with a tech-driven solution for you to find and make an informed decision when it comes to insurance products.

Get started on your gap cover journey by visiting the GAP IT website at gicover.co.za.

The website offers easy to understand resources for anyone wanting to learn more about gap cover and also serves as a channel for you to get the conversation started with GAP IT. You simply complete a quick and easy contact form and a GAP IT expert will get in touch to discuss your options. It’s as simple as that!

GAP IT is on a mission to demystify gap cover and get more South Africans covered.

Without a doubt, the biggest asset to help grow one’s wealth is health. But, medical costs can result in a huge financial setback if unexpected health conditions are not fully covered by your chosen medical aid scheme. To help cover this shortfall, some South Africans turn to gap cover.

Medical gap cover can offer a solution to help consumers take care of their health and finances, but even with the benefits of gap cover, South Africans don’t seem to be signing up. According to the most recent Stats SA General Household Survey, as well as surveys carried out by major insurance providers, many South African medical aid members are still without gap cover. Statistics show that of the 8 million South Africans with medical aid, only 37% have gap cover. This indicates that many South Africans may still be confused by the concept of gap cover and perhaps even unsure of its value and necessity.

Mind the gap: Understanding medical aid shortfalls and co-payments

So, what exactly is gap cover? Depending on which gap cover option clients have, gap cover will reimburse them for co-payments and shortfalls not covered by their medical aid provider. One way that medical aid schemes try to keep contributions as affordable as possible for their members is through negotiations with hospital groups, doctors, specialists, and certain other medical service providers for better tariffs. The problem for medical aid members comes when the member chooses to not use these Designated Service Providers (DSPs).

There are many reasons a patient may choose not to make use of the medical aid scheme’s recommended DSPs — beyond perhaps reasons beyond their control, they may want to make use of a doctor or specialist that they know and trust, and one who knows the patient’s medical history.

However, if the patient’s chosen doctor does not levy rates at an agreed tariff with the medical aid scheme, or charges rates that exceed the member’s medical aid option, then this may come at a significant cost to the member, for example shortfalls on the doctor’s bill.

Furthermore, many medical aid scheme options require members to make co-payments for certain predetermined procedures – which can result in hefty contributions from the medical aid member.  The same goes for the use of a non-approved hospital as well. In this case it can lead to hefty penalties for members when they are admitted to hospital for elective procedures. Fortunately, higher end gap cover options can, to a certain extent, compensate for the use of non-network hospitals as well.

If a medical aid member prefers not to be restricted to a DSP network, then they can opt for more comprehensive medical scheme benefit options. However, these options come at a higher contribution level. Even on options which offer freedom of choice with regards to providers, there may still be shortfalls on doctors and specialists bills as on the very top-end comprehensive plans remunerate at the private (300%) rate. In this case, gap cover may be the best solution for you to get the medical cover you need.

Why aren’t South Africans signing up for gap cover?

There are roughly 20 medical gap insurance providers operating in South Africa with over 85 different plans to choose from across the board. But, even with the prevalence of gap cover offerings in SA, many consumers find the process of signing up to be overwhelming.

With each provider offering seemingly the same product for medical aid members, it can still be confusing for consumers to figure out which product is right for their needs. Many consumers aren’t always aware of exactly what their gap cover policy entails — what they are covered for, and what they aren’t. So, while the concept of gap cover may be appealing to many, consumers don’t have the time or know-how to wade through complicated jargon and figure out what gap cover insurance policy would be worthwhile signing up for — not to mention what to expect at the claims stage.

Generally speaking, gap cover products can only address medical expense shortfalls for something that has been partially covered by a patient’s medical aid. If a patient’s medical aid doesn’t cover a certain procedure or specialist bill at all, then your gap cover won’t be able to assist. In other words, to truly have an understanding of what a gap cover policy will offer its client, the starting point is to fully understand your medical aid cover. Consumers need to immerse themselves in the details of their policies, but even this process can be overwhelming.

Demystifying gap cover

But what if an expert could hold your hand through the whole process? That’s where GAP IT comes in.

When choosing a medical scheme or a new product option, it is crucial for the client to unpack and understand all the benefits, whether the DSP network works for their healthcare needs, what co-payments they will be responsible for, plus all the finer details along with the costs thereof.

In putting together their healthcare funding strategy, it is important for clients to understand what will be covered and equally important, what is excluded, and how they can mitigate the risks and costs in an affordable and effective way using supplementary products such as gap cover. Admittedly, this is a complex task with many moving parts, and it is best tackled with the guidance of a professional healthcare intermediary.

GAP IT aims to make the gap insurance application process, after-sales service, and claims process as accessible as possible. It may be easy for consumers to get gap cover online, but there is the risk that it might not be the right gap cover product for their needs.

GAP IT takes it back to ‘old school’ methods by holding the consumer’s hand through the process of getting the most suitable gap cover for themselves and their families. Forget call centres with a script aimed at signing you up as quickly as possible. GAP IT clients speak to an expert that takes into account their specific needs and current medical aid scheme to help them find the best gap cover product for them.

Once the client has decided with the GAP IT expert what is the best gap cover provider and plan for them, the paperwork is done efficiently and timeously. This makes getting cover as easy and stress-free as possible for the client.

GAP IT also promises a ‘proof is in the pudding’ approach when it comes to clients being covered. When issues occur and the client needs their gap cover, GAP IT will manage the claims and queries on their behalf. When the client needs the gap cover service, they simply contact GAP IT, who will ensure a smooth ride in the claims process. Rather than dealing with a call centre, GAP IT has the client’s back every step of the way to ensure that they can file a claim as quickly as possible.

It’s this emphasis on old school-style personal service that sets GAP IT apart from the rest of the gap cover products available in South Africa. GAP IT aims to bridge the divide for consumers by combining very personal service with a tech-driven solution for customers to find and make an informed decision when it comes to insurance products.

Clients can get started on their gap cover journey by visiting the GAP IT website at gicover.co.za.

The website offers easy to understand resources for anyone wanting to learn more about gap cover and also serves as a channel for clients to get the conversation started with GAP IT. Potential clients simply complete a quick and easy contact form and a GAP IT expert will get in touch to discuss their options.

Liquidation of Constantia Insurance Company Limited – Important information for policyholders 

On 26 July 2022, the Gauteng Division of the High Court placed Constantia Insurance Company Limited (CICL) under provisional curatorship due to the insurer’s failure to meet its minimum capital and solvency requirements as set out in the Insurance Act, No. 18 of 2017.

The Prudential Authority (PA) also directed CICL to stop taking on any new business to help prevent a further deterioration of its finances and to protect policyholders while the provisional curator made attempts to find potential investors to restore the insurer’s financial position to an acceptable level. 

Despite efforts by the provisional curator to restore CICL’s financial position and save the business, the provisional curator concluded that CICL is insolvent and that there are no reasonable prospects of salvaging its financial position. The provisional curator therefore recommended to the PA that CICL be placed under liquidation. On 14 September 2022, the Gauteng Division of the High Court granted an order placing CICL under final liquidation. 

Further details about the liquidation, including important information about the impact of the liquidation on existing CICL policies can be found on the PA’s website.

The FSCA is aware that the provisional curatorship and liquidation of CICL have significantly impacted current CICL policyholders as well as underwriting managers and other intermediaries that have existing business relationships with CICL. The FSCA is also aware that other insurers have engaged in negotiations to take over insurance policies previously underwritten by CICL.

The FSCA welcomes proactive engagements with such parties to ensure that any such negotiations and potential changes in insurance cover are done responsibly, with due regard to applicable regulatory requirements and in the best interests of policyholders. Failure by any impacted insurer, underwriting manager or intermediary to act in the best interests of policyholders may result in regulatory action being taken by the FSCA. 

Existing CICL policyholders must please note that their current policies with CICL will terminate on 30 September 2022. They will need to secure cover with new insurers with effect from 1 October 2022. The FSCA recognises that this may not provide brokers with sufficient time to contact all impacted policyholders to give them options for suitable alternative cover. The FSCA strongly encourages CICL policyholders to urgently contact their brokers or financial advisors for future coverage options to ensure uninterrupted insurance cover. 

The FSCA also notes with concern that certain CICL policyholders with valid motor vehicle claims are experiencing challenges with securing the release of their vehicles from service providers such as panel beaters and autobody repair shops due to non-payment of claims by CICL. This is resulting in grave inconvenience and unnecessary storage costs for policyholders. The FSCA urges service providers to immediately release vehicles if no repairs have been made or to allow claimants to settle payments directly to secure the release of their vehicles. 

Policyholders who have questions or concerns about their current CICL policies or the status of their claims must contact the liquidators of CICL: 

Mr Cloete Murray and Mr Zaheer Cassim 
Email address: liquidator@constantiagroup.co.za 

The FSCA will continue to communicate regularly with the PA, the liquidators, and other stakeholders to monitor the impact of the liquidation process on policyholders. 

Enquiries: Financial Sector Conduct Authority 
Email address: communications@fsca.co.za 
Telephone: 0800 203 722