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.