What is GAP cover?

Gap Cover is a short-term insurance policy which covers the shortfall between what the Doctors charge over and above the medical aid rate. In most cases the medical aid scheme will need to cover the cost from the Risk or hospital benefit.

Gap Cover will not provide cover if the medical aid has not paid a portion of the cost, per line item of the medical procedure.

Should I get Gap cover?

Gap Cover is always recommended as a product to compliment your Medical Aid. This is to ensure no nasty surprises after a hospital admission. Most Gap Cover products also have additional benefits built in to assist with unexpected medical expenses. E.G., co-payments, casualty benefit, oncology extender benefits, premium waivers just to name a few.

Does Gap cover pay for MRI?

Gap Cover will not cover the cost if your medical aid does not cover a portion. Many medical schemes impose a co-payment and if your Gap Cover includes co-payment cover you will be able to claim this back.

Is Gap cover tax deductible South Africa?

Gap Cover contributions cannot be used as a tax deduction.

Does Gap Cover have a limit?

Legislation stipulates that Gap Cover does have an annual overall limit; this limit increases every year as of 1 April. The limit as of 1 April 2022 is R 183 000 per beneficiary per annum.

Does Gap Cover have waiting periods?

Yes, Gap Cover does have waiting periods. The general rule is a 3month general waiting period and between a 10 to 12 month waiting period on pre-existing conditions. Most Gap Covers also have a list of pre-defined conditions which carry a 10-month waiting period

When to contact us to make change to your Gap Cover product?

If you already have a Gap Cover policy, please remember to contact your broker should anything change. It is important for us to revise your option if you have changed medical aid schemes or options, had any life changing event e.g., married, had a child or diagnosed with a medical condition

Submitting a Gap Cover claim?

No pre-authorisation is required for a Gap Cover claims, the reason for this is you will not know before the procedure what the medical aid scheme will cover.

To submit a Gap Cover claim the Gap provider will require a fully completed Gap Cover claim form, hospital account even if you have no shortfalls on the hospital side, Medical aid detailed claim statement and all doctor accounts reflecting a shortfall.

The turn around time for normal claims is 10 working days once all documents are received and if the procedure is a Prescribed Minimum Benefit the turn around time may be longer.

If you are a Vision client for Gap Cover please send us the above documents for submission as then we are able to track and assist with the claim.

Is Vision Risk and Investment Consultants able to assist you with Gap Cover?

Yes, we are and we are able to offer a number of different options to ensure this fits your medical aid and budget.