AS THE cost of medical care (and particularly specialist medical services) continues to escalate, Gap Cover comes to the fore as a way to avoid hefty medical bills.

Gap Cover helps to bridge the shortfall between specialist rates and medical aid rates, explains Tony Singleton, CEO of Turnberry. “Your medical scheme often may not pay for your private healthcare fees in full, which is where Gap Cover comes in: for co-payments, sub-limits and other shortfalls.”

Singleton believes that choosing the right Medical Aid and complementary Gap Cover is an important decision for every individual and household, affecting both our health and our financial security.

Over time, as we move from one life-stage to the next, and encounter unexpected knocks along the way, we need to continually re-assess our cover.

He points to 7 key considerations when selecting a Gap Cover product:

1. Trust and surety
The number one consideration can be distilled down into one word: trust.
You and your broker must have absolute faith in the Gap Cover provider, absolute confidence that shortfalls will be handled. Look for a provider with a stellar reputation, strong financial position, and the energy to continually stay one step ahead of the market and innovate with new products and new partnerships.

2. Comprehensive coverage
Recent regulatory changes have capped Gap Cover to R150 000 in cover, per person per year. However, within this it’s important to understand the ‘maximum rate’ of your policy. So, if a specialist charges 400% of medical aid rates, you will only be able to cover the entire shortfall if your Gap Cover is also set at 400% or more. In many of the more basic Gap Cover options, the maximum rate may only be in the region of 200% - which is sometimes not enough to cover specialist shortfalls entirely.
It’s also important to consider cover for sub-limits, co-payments and deductibles - as certain types of Gap Cover will handle shortfalls due to you reaching your Medical Aid scheme’s sub-limit for a particular benefit, or because the scheme imposes a co-payment or deductible. This can provide handy additional cover when it’s most needed.

3. Tailored to your needs
We all have unique family histories, needs and problems. It’s essential to choose a Gap Cover alongside your traditional Medical Aid cover which fits with your circumstances. It’s only through a comprehensive, structured conversation with your broker that you will determine the right product fit for your needs.

Gap Cover should be seen as one aspect of your broader financial risk management strategy, working in harmony alongside all other forms of insurance (eg household, vehicle, life, disability/dread disease, and medical aid). As your needs and your family changes, the nature of your risk products also need to evolve.

4. Quick onboarding
With an estimated 600 000 South Africans utilising Gap Cover (versus a total number of 6 million using Medical Aid alone), there’s an urgent need for greater market awareness, and seamless on-boarding of new customers. Once you’ve selected the right cover for your needs, your chosen Gap Cover provider should work with your broker to ensure a hassle-free onboarding process, to ensure you and your family benefit from immediate cover.

5. Customer-centricity and relationships
This is something very close to our hearts. At Turnberry, we place great importance on customer-centricity - ensuring that every aspect of our offerings and our operations are finely-tuned to respond to what customers are looking for. By remaining highly-engaged with our broker network, and listening attentively to end-users, the providers of Gap Cover can ensure the best possible service to all stakeholders.

6. Waiting periods
Each Gap Cover policy will implement certain waiting periods for new joiners - generally relating to pre-existing conditions. If you suffer from chronic, long-term conditions, it’s important to pay especially close attention to the waiting periods required by Gap Cover providers.

7. Value
It’s not necessarily about choosing the cheapest Gap Cover, but the one that provides the best value for your needs. With Gap Cover options ranging from less than R100 per month to many hundreds of rands, for a more comprehensive policy, don’t overspend by taking out cover that isn’t necessary, and don’t underspend by choosing a policy that won’t match the shortfalls that you’re likely to need.

Gap Cover should be paired with your Medical Aid policy, to ensure that you and your family are adequately covered for every medical eventuality. With some specialist rates at four or five times the tariff, Gap Cover is becoming well-recognised as a vital tool at your disposal. But take your time to choose wisely, and thoroughly research the detail of the policy, to ensure it's the right fit.