Mind The Medical Aid GAP

When it comes to private healthcare and medical insurance, gap cover is a small step with huge treatment strides

- Samantha James

When 32-year-old Rorisang Gumede’s* husband started showing severe flu-like symptoms, the couple feared the worse. This was two months ago, and just as South Africa started reporting almost daily increases in the number of coronavirus-related deaths. So, their fears were not unfounded. “It was like the flu, but more severe. He had the shivers and his body temperature kept jumping from37-39°C, which is considered mild. “His breathing was okay and even though he couldn’t hold down any liquids or food, I decided to quarantine him at home and treat him with cold and flu medication, and hope for the best,” Gumede says. With two toddlers who are in constant need of medical attention for nicks and bruises, their medical aid cover takes quite a dent from month to month.

Medical aid schemes in SouthAfrica currently reimburse doctors and specialists at 100%, 200% or 300% of the scheme rate. In reality, however, professional medical providers may charge up to five times the base tariff. “I didn’t want to tap into our cover before first trying home treatments. In the past, I had experiences where our medical aid was exhausted because of over-the-counter medication and doctors’ inflated rates.” By the next day, her husband’s fever reading was 42°C and she immediately called an ambulance, which arrived within 30 minutes. This, she says, would have turned out differently if they did not have medical cover through a leading insurance provider. “My husband went through the worst of it, and it was touch-and-go for a few days. But, he is home now, and while he is not 100%back to his physical self, he is out of the woods.”