Getting caught in the gap between procedural costs and medical aid benefits can be troublesome to say the least.
One of the biggest issues regarding medical aid schemes today, is the question of whether they will pay or at least partially pay for the medical procedures we as consumers undergo?
This question can most certainly be answered by looking at your medical practitioner!
The Department of Health annually publishes the NHRPL (National Health Reference Price List) which serves as a guideline for medical aid schemes and medical practitioners to adjust their benefits/tariffs for the year to come. Thus, the annual medical aid price increases, we have all come to dread. But this serves only as a guideline, leaving medical practitioners free to charge whatever they want for the services they provide.Most medical aid plans offer either 100%, 200% or 300% coverage according to scheme tariffs, but 100% in this instance does not mean 100% coverage. It simply means that you are covered once, twice or three times for the scheme rate.
E.g. Your anaesthetist charges you R12 500.00 during a minor surgery, and your medical aid (with 100% Scheme Tariff Cover) only pays R4 166.66. It is safe to assume that your anaesthetist charges his services at 3x medical aid tariff, leaving you with a shortfall of R8 333.33 and a very empty pocket.
This is where GAP Cover can spare your bank. Stratum Benefits will cover you when your service provider charges considerably more than what your medical scheme pays for. Stratum Benefits provides you with an additional 500% cover when you become liable for the difference between these providers. This cover extends to doctors and specialists, basic radiology, pathology, physiotherapy, disposable medical items etc.
Don’t let the GAP ruin or restrict your financial freedom, take control and bridge the GAP.
- Provides an additional 500% cover;
- Cover for everyone on your medical aid plan under one premium starting from as little as R180.00 p/m;
- A variety of plans suited for any registered medical aid scheme;
- Extra benefits (depending on plan choice) including oncology benefits, sub-limit benefits, co-payment benefits etc.
Contact G and S Insurance Consultants for your tailor-made Stratum Benefits GAP COVER option today!
**waiting period/limits/restrictions may apply**