Every Gap Cover policy is different and it’s up to you make sure you understand the fine print and exclusion of your individual policy. However, this is a list of general exclusions most Gap Cover providers will not pay for:

  • Ward costs in a hospital or step-down facility
  • Upgrades to a private room
  • Pre-admission consultation costs
  • Medication (both in-hospital and take-home)
  • External prostheses (an artificial breast or a prosthetic leg)
  • External appliances, such as wheelchairs or crutches
  • Routine medical examinations, such as ultrasounds
  • Home or private nursing
  • Extra costs related to weight/BMI-related procedures
  • Mental health disorders, transportation costs (such as in an ambulance)
  • Out-of-hospital dental treatments
  • Cosmetic procedures
  • Costs incurred for treatment by a non-designated service provider (determined by your medical scheme)
  • Co-payments for any procedure for which you are in a waiting period.

It’s important to understand that Gap Cover won’t cover something that your medical aid excludes. It only tops up a shortfall on approved procedures, specialists or medications.

The verdict: is Gap Cover worth it? 

Unequivocally, the answer is YES. If you have medical aid, you should have Gap Cover to complement it. Medical procedures are expensive… expensive enough to lead to life-changing debt if you don’t have sufficient protection in place. Gap Cover is a relatively inexpensive way to protect you against potentially crippling debt from medical aid shortfalls.

Article credit: https://www.iwyze.co.za/post/it-worth-coughing-gap-cover

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