Opinion Piece: Are you covered against medical expense shortfalls from accidents for long weekend holidays?
Gap cover covers you for medical expense shortfalls, co-payments, and (on some plans) emergency room visits for both accidents and illness.
Long weekend holidays can be a time of increased accidents and injuries, both on the road and at home. From car accidents to sports injuries and household mishaps, emergency medical care may be necessary and medical expense shortfalls can result.
While medical aid may cover a portion of the costs, gap cover can help cover the gaps and prevent significant out-of-pocket expenses.
Accidental harm
Car accidents are especially common during long weekends, as people often travel long distances to visit family and friends. Injuries from car accidents can range from minor cuts and bruises to more serious head and spinal injuries. However, accidents can happen at any time, including at home or during leisure activities.
Unfortunately, medical aid may not always cover the full cost of emergency medical care. For instance, if you cannot find a hospital in your network while on holiday, you may face non-Designated Service Provider penalties.
Even if you are treated at a network hospital, co-payments and shortfalls on doctor and specialist bills can add up to significant amounts, especially for ongoing treatments.
Falling short
Treatments that are not an emergency at a non-DSP hospital will typically involve a co-payment of up to R10,000. Even if treatment is sought at a network hospital, there can still be co-payments attached to certain procedures and treatments that can be up to R34,000 or even more.
Then the treatments themselves can result in shortfalls on accounts for doctors and specialists, as they may charge many times the medical aid rate, particularly when it comes to spinal and muscular-skeletal problems.
For example, Turnberry Management Risk Solutions has paid a claim for R119,617.50 for cervical disc replacement. The total bill was R164,774.20 and the patient’s medical aid paid just R39,048.10 of this.
These sums are not uncommon, with disc disorders resulting from accidents frequently leading to medical expense shortfalls of over R100,000.
Aside from the initial injury, complications can arise, as in the case of a malunion of a fracture, which is where a broken bone fails to heal correctly. Turnberry have paid claims of more than R80,000 for these treatments.
Are you covered?
Without gap cover, these patients would have been left to try and find massive sums of money, decimate their savings, or make long-lasting payment plans with the treating physicians.
Gap cover covers you for medical expense shortfalls, co-payments, and (on some plans) emergency room visits for both accidents and illness.
Having gap cover to augment medical aid provides a safety net that can safeguard your financial well-being and give you peace of mind as you enter the holiday break. Speak to your broker or financial advisor to help you find the best gap cover plan to suit your needs.
