SOUTH AFRICAN GAP COVER: COVERING YOUR BILLS WHEN YOUR MEDICAL AID FALLS SHORT

Similar to taking out ‘Excess’ cover as a priority when renting a car on holidays, South African Gap Cover has become as essential as the medical aid product itself. With the rocketing costs of private medical healthcare, gap cover has become a key conversation in the quest for affordable health that ticks all the financial boxes and ensures that a medical emergency is not further compounded by a financial burden. ‘Gap Cover’, by definition, is a low-cost, top-up insurance that any medical aid subscriber in RSA can take out, that covers the difference between what your insurance provider approves and pays, and the actual cost of treatment or hospitalization as a result of a medical emergency. If you urgently require a certain treatment or access to a specialist, ‘time to shop around’ is not of the essence! Gap Cover is designed to cover any shortfall that may be incurred.

The Benefits of South African Gap Cover

The core benefit of taking out a gap cover policy, allows you to vastly reduce or eliminate any out-of-pocket expenses associated with primary healthcare or hospital treatment you may require, while on medical aid. As long as you are a contributing member to a medical aid scheme and have served the applicable waiting periods associated with any approved prescribed condition, your additional cover will take effect to ensure your physical burden does not become a financial one. South African Gap cover is priced at a fraction of your conventional medical aid plan. Acquiring comprehensive cover is economical and forms a vital safeguard for your family against costly medical events.

Day1Health

If you are strongly considering gap cover, Day 1 Health offers current medical aid subscribers an affordable plan that bridges the gap should your medical scheme not reimburse your claim in full. Offering exceptional value for money, Day 1 Health members can benefit from a host of additional services, not limited to medication, basic dentistry, and unlimited GP visits as part of our 1 Doctor Health Network. Cover for all eventualities by Applying Online Today.

SOUTH AFRICAN GAP COVER: What is a Medical Aid Co-Payment?

One of the harshest challenges facing RSA citizens’ access to affordable healthcare has been the steady increase in co-payments demanded, either by specific medical specialists, or for certain medical procedures. This is the motivating factor for taking out South African gap cover in order to avoid any nasty surprises in your hour of need.

What is a Medical Aid Co-Payment?

Should the cost of your treatment, procedure or hospital stay exceed the maximum amount of your current medical cover, you are personally liable to pay the difference out of your own pocket. This is likely to be something you completely overlooked in the small-print when signing your medical aid policy and it can have a devastating financial effect. The added stress of extra hidden costs is the last thing you want to encounter when your focus should be on recovering and resuming a normal life. With gap cover, this scenario is avoidable. Gap cover is a non-compulsory, but highly recommended insurance product which any current medical aid member can subscribe to. It is tailored to cover these excess payments, for a minimal monthly premium. Essentially, gap cover is your shock-absorber, ensuring that a medical emergency does not become a personal financial crisis. It is important to note, however, that a South African gap cover product will not cover you for any exclusions on your current medical aid scheme

Taking out Gap Cover

A product in which the benefits (when activated) far outweigh the costs involved, we believe it is imperative to enrol your family on a South African Gap Cover plan. Taking out a plan is not restricted to the medical aid provider you are currently with. Both financial, and medical insurance companies now offer specialized gap cover plans, ensuring your family’s peace of mind and comprehensive healthcare protection in RSA. Regardless of your income, Day1 Healthoffers a solid gap cover plan that will meet your budget and your family’s needs. With a host of additional benefits, it represents the premier gap cover product in South Africa. Apply Online today, and say goodbye to any future medical bill shocks!

South Africa Gap cover – MIND THE GAP

If you have ever travelled on the London Underground, then you will be familiar with the robotic and recorded, ‘Mind the gap’ warning, as train doors open and close. This warning is imperative for your safety.

The same warning applies when you consider your Medical Aid benefits and what you are covered for. Even though you may be paying a seemingly large amount for your Medical Aid benefits, private healthcare practitioners are often charging above the Medical Aid stated tariffs – leaving you to pay the difference from your own pocket. You are responsible for ‘minding the gap.’ This is where South African Gap Cover comes in.

What is Gap Cover?

Essentially, Gap Cover is an extra policy that covers the financial shortfall between what your Medical Aid tariff pays out, and the actual rates charged by private healthcare practitioners for hospitalisation treatments and procedures. If you are 60 years or younger, and already registered with a medical aid scheme in RSA, you are eligible for Gap Cover.

Why do you need it?

Consider this scenario: Your child has had multiple cases of tonsillitis in a year and is now scheduled for a tonsillectomy. Your medical aid has given hospital pre-authorisation and will cover an estimated R1 872 for the procedure. The actual cost of the surgeon and anaesthetist rates and post-operative medicines might come to around R5 222. You would then be responsible to cover the outstanding R3 350. Of course, depending on the procedure, and your Medical Aid scheme, this could escalate to exorbitant amounts. A back fusion could have you forking out a potential R18 000. This is where South African Gap Cover fills the payment gap.

Some Gap Cover policies might even offer further outpatient benefits for procedures such as MRIs, CT scans, chemo, radiotherapy and kidney dialysis.

What else do you need to know?

If your Medical Aid scheme does not cover stated exclusions, your Gap Cover will not cover these either. Examples of exclusions might include fertility treatments and cosmetic surgeries.
Some Gap Cover policies might also set a maximum amount for shortfall payouts – which may only end up being a contribution towards the overall difference.
Waiting periods might also apply – so make sure you check all the fine print and get clarification from the agent before you sign on.

Day1 Health offers a Gap Wise option. Please visit our website to find out more or contact us to request a quote.

SOUTH AFRICAN GAP COVER – ‘BE PREPARED’

Boy Scouts and Girl Guides live by the motto, ‘Be Prepared.’ It is a wise motto for all. Moms do it by default – their bags are always stocked with extras, and an umbrella…just in case. Dads do it by making sure there is a rugby or soccer ball in the boot…just in case. Broadly speaking, we like to be prepared.

But we cannot be prepared for every eventuality. That is the unique benefit of medical South African Gap Cover –it is your ‘be prepared’ for ‘just in case.’When it comes to looking after our health, there are many things we put in place to be prepared.

We join a gym or exercise programme

We are all aware of the benefits of regular exercise. It aids better sleep and helps to lower the risk of some diseases (including type 2 diabetes and high blood pressure), as well as helping to overcome mild depression. We are prepared to pay for gym memberships, Pilates classes and ‘Walk for Life’ programmes when it comes to putting steps in place to look after our health.

Exercise is also beneficial as part of a weight loss programme. Many South Africans struggle with being overweight. Worryingly, with obesity on the rise in adults and children, there are concerning health risks. And what if you put your back out while exercising? This might prompt you to consider Gap Coverjust in case you require a visit to the hospital.

We embark on a healthy eating plan

There is much information out there warning us of the health risks of additives, too much sugar, and consuming too much processed and fast food. That hopefully has us all rushing to the food pyramid to ensure we eat a balanced and healthy diet. However, being prepared to give up regular trips to KFC and limiting our sugar intake is not a guarantee against needing a hospital procedure. South African Gap Cover might be worth having…just in case.

We take out Medical Aid

When it comes to budgeting for your family’s health, one of the top priorities is Medical Aid. You will make financial sacrifices to make sure you and your family’s health is covered and provided for. You scrutinise the benefits and options so that you are prepared for when you need that hospitalisation procedure or treatment.

We might need to consider Gap Cover

In a previous blog entitled ‘Mind the Gap,’ the basics and benefits of Gap Cover were outlined. With rising medical costs compounded by your Medical Aid provider only paying a percentage of your bills, Gap Cover is a solid option to consider to cover the financial shortfall. It’s your ‘backup plan’, helping you to ‘be prepared’ for that ‘just in case’ eventuality which you cannot always be prepared for.

If you would like some more information on Day1 Health’s affordable Gap Cover option, Gap Wise, and what it covers, please visit our website or contact us to speak to a consultant.

MEDICAL AID RSA AND MEDICAL INSURANCE KEY DIFFERENCES

Knowing the difference between medical aid rsa and medical insurance allows you to make an informed opinion that can optimize you and your family’s well being without costing an “arm and a leg”. Health Care in RSA is perceived as being an expensive luxury, encumbered with numerous restrictions and prohibitive premiums. Acquiring a comprehensive medical aid plan to cover all unforeseen setbacks can cost you thousands of Rands through the restrictions placed upon members to use certain health specialists listed on a medical aid provider’s network. With the benefit of health insurance, members have more flexibility upon where they seek medical attention. In a tough economic climate where price-sensitivity effects consumer behaviour, medical insurance products ultimately present a tailored ‘benefits’ package, with the inclusion of additional extras such as personal accident, permanent disability, and funeral benefit.

Medical Aid – The Cost of Prescribed Minimum Benefits (PMB’s)

A key factor in the rising costs of medical aid premiums in South Africa can be identified in providers encumbered, by law, to cover the entire costs of all medical costs attributed to chronic conditions and Prescribed Minimum Benefits. These PMB’s include life threatening conditions such as asthma, cardiac emergencies and (See complete List) Medical insurance providers are not bound by the same legislation, and as such, can offer tailored medical benefit plans at much lower premiums to a wider portion of the population.

The affordable alternative to medical aid

As a ‘Stated Benefit Insurance Plan’, Day 1 Health is regulated by the Council for Medical Schemes as a low-cost benefit option medical scheme in terms of the Medical Schemes Act of 1998. In the absence of restrictive PMB’s, Day 1 Health offers a range of affordable Medical Insurance Packages accessible to all South Africans, offering both daily and hospital cover. General and pre-existing waiting periods draw parallels with conventional medical aid schemes, with waiting periods of just 1 month applied to certain daily benefits such as GP visits, radiology and acute medication. Whether you require a Prepaid Preventative Plan or would like to combine it with the added incentive of Hospital Benefits, Day 1 Health has a healthcare solution for all RSA citizens. Apply Online Today and say goodbye to spiralling medical aid costs.

MEDICAL AID RSA CO-PAYMENTS

One of the key instigators of the rising cost of healthcare has been the system of co-payments – the extra payments that certain private health providers charge your medical Aid RSA scheme.

Despite the well-documented pressures associated with the rising cost of living in RSA, citizens are resolute in maintaining their medical aid RSA cover as the prices of everyday consumables skyrockets each month. Heaven forbid, should anything unforeseen occur and you require immediate emergency treatment, your medical aid contributions will grant you access to the healthcare you need, saving your life in many instances. However, the reality is that medical aid premiums have become too expensive to maintain for most families. The concept is outdated and limited to the elite few. Here’s how you can make arrangements to avoid these hefty extra payments and help steer the tide in bringing down healthcare costs.

Get Accustomed to your Network Provider List

Check your medical aid scheme or insurance plan. Depending on the insurer and policy you are covered under, you will be encouraged to choose between a list of GP’s, hospitals, pharmacists and specialists with an agreement in place to prescribe their services without being liable to pay an additional co-payment. With relationships cemented between the healthcare provider and the medical aid or insurance companies, bills are often settled directly between the two parties, saving you the administrative headache of lodging claims and chasing refunds.

Always ask in Advance if you’re liable for Co-Payments

Although it may feel embarrassing to discuss finances with your healthcare provider, you’re perfectly entitled to enquire if a specific appointment requires a medical aid co-payment or additional tariff. It affords you the opportunity to shop around, should the cost be prohibitive. The 1 Doctor Provider Network,established by Day1 Health is a testament to how a strong and stable partnership with private practitioners nationwide can help drive costs down, keep your monthly premiums low while ensuring you receive quality healthcare without the fear of hidden extra costs.

Say Goodbye to Costly Co-Payments

While medical aid RSA companies aim to incorporate as many network practitioners and clinics as possible under their umbrella, there is inevitably a percentage of doctors and specialists who operate outside any given medical scheme. By availing of one of Day 1 Health’s tailored Benefit Plans, members can choose from a nationwide network of GP’s and dentists with an additional allowance of three out-of-area visits per family per annum. The system of medical aid co-payments is coming to a close – you can end the cycle today by Applying Online today.

MEDICAL AID RSA AND HEALTH INSURANCE

There is an old saying that goes “prevention is better than cure”. This applies not only to the Medical aid RSA industry, but to the entire human population as a whole. If citizens follow a holistic lifestyle, stick to a healthy diet and engage in regular exercise, the need for medical check-ups and the onset of chronic diseases can be minimized. Both medical aid and health insurance companies are fully aware of this – many having tailored ingenious wellness programmes designed to keep the population in good overall health while relieving the pressure on an already overburdened health system.

Take Care of Yourself – At Home, at Work and at Play

We hear these phrases everywhere we go – whether it is being reminded of the importance of a well-balanced breakfast, the intake of 8 glasses of water a day, or the brisk daily walk that keeps heart and cholesterol problems at bay. South Africa’s largest medical aid providers have taken wellness programmes even a step further by rewarding healthy living with a portfolio of benefits to their members. Discovery Vitality and Momentum Multiply offer members discounts on gym memberships, healthy food items and activity monitors by accumulating ‘points’. However, with the commercial lure of gimmicks and gadgets and despite the uptake to these wellness schemes, we are not seeing a lowering of medical aid premiums. Take a look at the alternative..

Health Clinics – The Secret to bringing down Healthcare Costs

For the majority of the South African population, medical aid is just too expensive to afford and maintain, and seems to be merely sugar-coated with frills, gym-towels and Olympians to justify its costly monthly price tag. Day 1 Health has approached health and wellness in a simple and direct manner, with the intention of driving down the cost of healthcare while boosting the well-being of all its clients. The company has already launched its first clinic, offering primary health care benefits that clients need, when they need it. In addition, a weight-loss clinic has been successfully integrated into the clinic to monitor any clients with higher than normal B.M.I. With the overwhelming success of their flagship clinic in Mayfair, Johannesburg, plans are already in place to introduce similar facilities across South Africa. It’s time to say goodbye to that medical aid sponsored gym card that never gets utilized. With a host of primary healthcare and hospital cover plans starting from just R265 per month, leading a healthy lifestyle is no longer a luxury of the elite. Apply Online Today.

MEDICAL AID RSA – RESTORING YOUR HEALTHCARE COVER

Medical Aid in RSA is a vital resource which, in an ideal world, would be universally available to all. However, for a multitude of reasons, South Africans’ citizens face the harsh reality of having to cancel their medical aid policies. When your outlook improves and you are able to restore your medical cover, how easy is the process, and what other options exist at better value for money?

Primary Reasons for Leaving a Medical Aid RSA Scheme

With the gap between those who can afford medical aid and those who cannot – widening each year, the Department of Health, along with StatsSA, sought to determine the root causes of why RSA citizens leave their medical schemes. As reported in the 2016 Demographic and Health Survey, the following circumstances were cited as primary reasons for the cancellation of medical aid policies.

Reason for leaving Medical Aid	Percentage
No longer affordable	41%
I/my partner changed jobs.	11.6%
I/my partner became unemployed	11.2%
Was on a parents’ medical scheme but then left home	9.3%
Was a member through a previous employer. When I changed employment, the contributions then became unaffordable	13.1
Other	13.8%

The affordability of medical aid in RSA is the overriding factor in the cancellation of medical aids. The survey also lends weight to the assumption that many South African medical aid policies can only be sustained through the part contribution of employers and organisations.

What to expect when reinstating your Medical Aid or Insurance Policy

While there is an overwhelming sense of relief when you are in a position to reinstate your medical aid policy, you need to bear in mind that waiting periods will once again apply. Even if you were a member before, you are considered as a “new member”. Depending on how long you have gone without medical cover, you will have to endure waiting periods ranging from 3 to 12 months for certain specified conditions and treatments.

Medical Aid or ? What other options are out there?

Rather than cutting out your health coverage completely, closely examine the range of medical insurance options that exist in the South African marketplace. If you are looking for a Plan similar to medical aid, where premiums are much lower in accordance with limited benefits, look no further than Day 1 Health. With a range of primary healthcare, hospital cover, and combined options to choose from, and the assurance of shorter waiting periods on many benefits, reinstating your healthcare cover need not be a painful process. Apply Online Today to protect yourself and restore peace of mind.

HOSPITAL PLANS RSA – THE IMPORTANT ROLE OF WELLNESS ALONGSIDE

As you read the title of this article, you’re probably asking yourself, “What would health and wellness have to do with hospital plans In RSA?”. Quite a lot, actually! With the exception of unforeseen accidents and emergencies, leading a healthy lifestyle can go a long way in protecting your health and avoiding unnecessary hospital visits.

Rather than scaring you into undertaking a drastic lifestyle overhaul, consider the essentials of wellness while improving your chances of living to 100! With the support of adequate hospital cover, RSA citizens are protected against the medical costs associated with many chronic conditions. Always approach hospital plans in RSA from the perspective that they are a safeguard against expensive medical bills – not a license to live fast and hard. The long-term savings you can make towards your medical treatments is dependant on your mindset of “healthy body – healthy mind”. Add a few of these important life-hacks. Some may already be second-nature to you.

Exercise Regularly – While we tend to lead busy lives, making time for some moderate exercise – even a brisk lunchtime walk around the office park – can do wonders for your cardiovascular health. Not to mention improving your focus and helping you achieve a good night’s sleep.

Eat plenty of Veggies, topped up with Water

This basically means eating everything your mother told you to eat while you were growing up. Vegetables and fruit contain the majority of essential nutrients, antioxidants and vitamins we need to maintain a healthy lifestyle and stay on top of our game. Aim to supplement your “five a day” with at least 8 glasses of water – it combines to keep your weight in check, maintains a positive cholesterol level and keeps reliance on your hospital plans confined to last-case scenarios.

Don’t Smoke! – no further explanation needed. If you are struggling to quit, try these techniques, compiled by the Cancer Association of South Africa (CANSA)

Protect yourself with the benefit of South African Hospital Plans

Taking control of your wellness and health recognises that ‘prevention is better than cure’, and it all starts with a strong, motivated mindset and a positive approach to your body. With the benefit of comprehensive hospital cover from Day1Health, policy-holders can enjoy generous cash payouts upon admission to offset the costs of treatment. View our Plan Options to find a benefit plan tailored to your families’ needs. Apply Today.

THE MEDICAL AID – RESTORING YOUR HEALTHCARE COVER AFTER PREVIOUSLY CANCELLING YOUR POLICY

The Medical Aid is vital resource which, in an ideal world, would be universally available to all. However, for a multitude of reasons, South Africans’ citizens face the harsh reality of having to cancel their medical aid policies. When your outlook improves and you are able to restore your medical cover, how easy is the process, and what other options exist at better value for money?

Primary Reasons for Leaving a Medical Aid Scheme

With the gap between those who can afford the medical aid and those who cannot – widening each year, the Department of Health, along with StatsSA, sought to determine the root causes of why RSA citizens leave their medical schemes. As reported in the 2016 Demographic and Health Survey, the following circumstances were cited as primary reasons for the cancellation of medical aid policies.

Reason for leaving Medical Aid	Percentage
No longer affordable	41%
I/my partner changed jobs.	11.6%
I/my partner became unemployed	11.2%
Was on a parents’ medical scheme but then left home	9.3%
Was a member through a previous employer. When I changed employment, the contributions then became unaffordable	13.1
Other	13.8%

Affordability of the medical aid is the overriding factor in the cancellation of medical aids. The survey also lends weight to the assumption that many South African medical aid policies can only be sustained through the part contribution of employers and organisations.

What to expect when reinstating your Medical Aid or Insurance Policy

Medical Aid or ? What other options are out there?