Gap cover is a lifetime investment in financial and physical well-being

Medical aid is essential for accessing private health care in South Africa. Picture: Paballo Thekiso, Independent Newspapers.

Medical aid is essential for accessing private health care in South Africa. Picture: Paballo Thekiso, Independent Newspapers.

Published Jun 24, 2024


By: Brian Harris

Medical aid is essential for accessing private health care in South Africa, but increasingly, members are exposed to medical expense shortfalls, as well as co-payments and sub-limits, which can reach tens of thousands of rand per claim and add up to hundreds of thousands of rand over a lifetime.

Gap cover, once a nice-to-have, has become critical in shielding you from the detrimental financial impact of the costs. It is never too early or too late to take out a gap cover policy as a lifetime investment in physical and financial health.

Medical expenses do not discriminate based on age

The rising cost of medical treatment and increasing shortfalls in medical aid cover mean that medical expenses can easily become a burden. Although medical aid schemes will cover up to the medical aid rate, increasingly, specialist providers charge many times the rate, and the shortfall must then be covered out of pocket by the patient.

When you are young and healthy, it is easy to overlook this, but the reality is that accidents can (and do) happen to anyone and injuries related to car accidents, sports and physical activity could end up being costly. The older you get, the more likely you are to need costly medical treatment, and as you look to start a family, there are additional costs related to maternity, childbirth and then the health of your children that you need to take into account.

From stress-related illnesses to gastrointestinal issues, chronic diseases to muscular-skeletal problems and the ever-present chance of accidents and emergencies, the potential need for medical attention is ever-present. Whether you're just starting out in your career, enjoying retirement or anywhere in between, gap cover can be of massive benefit, cushioning you from unexpected costs related to medical expense shortfalls.

A lifetime of protection

As the cost of accessing quality private medical care continues to increase, medical expense shortfalls, co-payments and sub-limits are becoming more common, at higher amounts. This could mean that any medical treatment, regardless of your age or life stage, could end up costing tens of thousands of rand out of pocket. Over a lifetime, the sums could add up to significant sums that could put you under severe financial pressure without appropriate insurance like gap cover in place.

One example is a Turnberry client with cancer of the ureter and kidneys, which has required 20 treatments to date, with medical expense shortfalls totalling R529 599. Another client has lifetime claims totalling R450 225 to date for a variety of issues, including lung cancer, spinal stenosis and chronic obstructive pulmonary disease (COPD). A third has received gap cover totalling R398 585 for back problems, COPD, other lung issues, complications related to procedures and more. All the incidents occurred over multiple calendar years, which is why they have far exceeded the current Overall Annual Limit of R210 580.06.

These are staggering sums that the patients would have had to pay themselves had they not had gap cover, depleting any savings they may have had and potentially causing financial hardship, in addition to the added stress this would have caused. These are only a few examples, as there are many medical procedures that can result in significant medical expense shortfalls, including childbirth, spinal problems, cancer, heart disease, sinusitis and respiratory infections.

Gap cover to suit your needs

Gap cover providers have different options and plans available, making this insurance an indispensable asset that can offer peace of mind at every stage of life’s journey. However, it is always important to understand the different terms of cover that are offered, as some providers will impose a lifetime limit on claims. Speak to your financial adviser to ensure you get the best policy to fit your medical aid cover and needs, and make sure you carefully review the terms and conditions of any policy to understand the lifetime benefit, as well as any other limitations or exclusions.

* Harris is the GM of operations at Turnberry Management Risk Solutions.