Close the Gap and eliminate out-of-pocket expenses!

Comprehensive medical aid Gap Cover is now offered exclusively to Medshield Medical Aid members.

25 September 2024

JOHANNESBURG, 25 September 2024 - Even the most comprehensive medical aid plans may leave members with out-of-pocket expenses, often at the most inconvenient times. Medshield Medical Scheme (Medshield) understands this challenge and has partnered separately with Sanlam and Total Risk Administrators (TRA) to provide Gap Cover at preferential rates directly and exclusively to Medshield members. Additional financial protection becomes increasingly important as healthcare costs continue to rise, particularly for specialist treatments and in-hospital care where out-of-pocket payments may arise.

"As a medical scheme, we offer a safety net for many healthcare costs, but gaps can occur, especially when the costs of specialists or certain treatments exceed the rates covered by your benefit plan," states Kevin Aron, Principal Officer at Medshield. "Our collaboration with Sanlam and TRA offers a solution designed to close the gap between what your plan covers, and the actual costs incurred, ensuring that Medshield members can access quality healthcare without the stress of unexpected medical bills."

What Gap Cover is and what it's not

Gap Cover is not a substitute for medical aid, but a supplementary insurance product designed to protect you from financial shortfalls. It kicks in when your medical aid has covered its portion, helping to cover any remaining gap. For instance, if your medical aid covers 100% of the scheme rate for surgery, but the treating surgeon charges 300%, Gap Cover will help cover the remaining 200% you would otherwise have to pay yourself. The rising costs of healthcare have made Gap Cover an essential addition for all medical aid members.

While Gap Cover is also often confused with medical insurance, the two fundamentally differ. Medical insurance provides limited cover, often for specific events or conditions, and does not guarantee the same comprehensive benefits as a medical aid plan. It is designed as a lower-cost alternative for medical assistance, focusing on specific health-related incidents, and often the payouts don't cover the actual costs charged by a healthcare provider, e.g. a hospital or specialist.

In contrast, Medshield's partners offer a Gap Cover solution that complements medical aid, not replace it. It steps in when there is a gap between what you are charged and what your plan covers, specifically on in-hospital specialist costs, ensuring you do not face unexpected costs. To benefit from Gap Cover, you must be a member of the medical aid scheme. Gap Cover protects you from specific gaps, such as in-hospital shortfalls, co-payments, and specialist treatment costs that exceed your medical aid's coverage limits.

Medshield's Partnership with TRA and Sanlam

"Through our strategic partnerships with Sanlam and TRA, both of whom will administer their Gap Cover products directly, we have negotiated preferential rates and tailored Gap Cover solutions exclusively for our members to provide reliable protection against financial shortfalls.

This partnership ensures that members benefit from plans tailored to Medshield's unique structure, simplifying the claims process and providing financial peace of mind," states Aron.

Sanlam, a well-known and trusted brand in the insurance sector, offers an additional layer of financial protection to Medshield members with their Sanlam Gap Comprehensive and Sanlam Gap Core plans. These Gap Cover solutions are underwritten by Centriq Insurance Company Limited, offering competitive premiums and a seamless claims process. With Sanlam's Gap Comprehensive plan, Medshield members can save up to 12% on the normal retail cost, and the Sanlam Gap Core plan has been uniquely designed and priced for Medshield members. For example, Sanlam Gap Core starts at just R192 per month for individual members under 60 years of age. It makes it an affordable and essential option for those looking to protect themselves from unexpected medical bills.

TRA offers four Gap Cover plans tailored explicitly for Medshield members. With TRA's deep understanding of the medical aid industry and Medshield's structure, members benefit from straightforward claims processing and expert advice on selecting the right plan for their needs. These plans ensure that members avoid the stress of out-of-pocket expenses, providing a straightforward claims experience since TRA understands Medshield's claims processes.

Close the Gap and eliminate out-of-pocket expenses!

In a time of rising healthcare costs, Gap Cover is no longer just a luxury but a necessity. Medshield's partnership with Sanlam and TRA gives members the financial security they need to face unexpected healthcare challenges. By choosing Gap Cover, Medshield members are ensuring that they and their families are protected from the economic burden of medical shortfalls, allowing them to focus on what truly matters: their health and well-being.

"Medshield has many members who have partnered with us for 17 years and longer, knowing we have their best interests at heart. We are a stable organisation that will be around in the long term, with a menu of member-centric benefit plans to cover your needs as you navigate through life," states Aron. "The mission remains unchanged: to provide access to affordable, high-quality healthcare through partnerships, bringing our members more value at competitive prices compared to the market. We are confident that our member-centric business approach will continue translating into quality healthcare and excellent value for money," he concludes.

Medshield has gone the extra mile to ensure its members receive financial protection and peace of mind. View the exclusive Sanlam and TRA Gap Cover offering on www.medshield.co.za today.

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