Three facts that should be extremely concerning to all medical aid members:
Fact 1: Doctors and specialists charge significantly more than your medical aid will pay
Fact 2: You are liable for the shortfall
Fact 3: Accidents, illness, and medical emergencies can happen at any time
A common misconception is that a 100% medical scheme option will pay for 100% of a member’s in hospital treatment costs. This is simply not the case. The percentages used by medical schemes describe the percentage of the medical scheme’s own tariff list they will pay and are not an indication of the percentage of the treatment costs that they would cover.
Medical practitioners such as Doctors, Surgeons and Specialists are free to charge what they choose and they may even charge up to 400% of the medical scheme’s tariff. The result is a payment shortfall or Gap that is for the account of the medical scheme member.
These payment Gaps can be significant. For example members that are on a 100% medical scheme option would be liable for a personal payment of approximately R9 500 should they undergo a caesarean childbirth, a coronary bypass operation would leave a shortfall of approximately R29 500, hip replacement R18 000, knee replacement R14 000 and tonsillectomy R5 500. These are some of the frequent shortfalls that exist but in total there are thousands of procedures that would result in payment shortfalls. It is specifically these payment shortfalls that are covered by Medical Gap Cover.
Medical Gap Cover covers the difference between 100% of the tariff and the medical practitioners charge regardless of what your medical scheme pays which means that if you are on a medical scheme that pays more than 100% of tariff you will have extra cash in your pocket.
For a premium of R128 per month, cover is provided with a total annual limit of R165 000 per individual member and
R1 000 000 per family.
(Personal Accident Cover is provided to the member at no additional cost)
Click on the video or the following links to see how our products have benefited some of our clients:
http://www.youtube.com/watch?v=0qzDULr1hVo
http://www.youtube.com/watch?v=17NrH6Noyxk
The Terms and Conditions of this policy are available to you by contacting Zestlife via the submit page. Underwritten by Guardrisk Insurance Company Ltd. Zestlife Investments (Pty) Ltd is an authorised Financial Services Provider FSP: 37485 (Terms & Conditions apply)
