| GAP Cover:
Why do you need a Gap Cover benefit when you have a Medical Aid, surely your Medical Aid will cover all your in-hospital expenses?
Not so! The rate at which Medical Schemes pay for in-hospital procedures and the rate at which the service providers charge are two worlds apart.
Medical Schemes fund claims at a Scheme Approved Tariff, whilst Medical service providers usually charge for their time and expertise at a rate far in excess of the Medical Scheme Tariff.
What implications does this have for you the medical scheme member?
More often than not, there will be a short-payment on your in-hospital procedures account, due to the General Practitioner or Specialist charging in excess of what your Medical Scheme covers. This can in some cases be as much as three times the Scheme Tariff.
Depending on the nature and length of time of your in-hospital procedure, this short payment could be a fairly significant amount, leaving you the member significantly out of pocket.
What is the solution?
CompliMed
This product is designed for in-hospital procedures, to “fill the gap” between what is charged by your service provider in-hospital and what is covered by your Medical Scheme. The actual benefit paid is subjected to a maximum (300% of Scheme Tariff) as set out in the policy. Should your service provider charge in excess of this, then you would still be liable to cover this additional amount yourself. It is always advisable, wherever possible, to negotiate and confirm the best possible rates with your service provider to avoid excessive patient liability.
How do you go about registering for Gap Cover?
Should you wish to apply for this Gap Cover, kindly complete a Complimed application form and fax it to PROVIDENCE on the fax number (041) 395 4590. PROVIDENCE will collect the R67 per month from your payroll or via debit order where applicable and pay it across to Complimed on your behalf. PROVIDENCE will also assist you with the claiming process once you have been hospitalised.
Should you wish to find out more about this product or to obtain an application form, please feel free to contact the Medimed Customer Care team on (041) 395 4474.
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