Is Gap cover really needed?

This question comes up way too often to be ignored. The answer is yes, yeeesssss, yeeessss, it’s an emphatic YES.

For over 10 years now my family and I have never been without gap cover. I have spent roughly R24 000 in premiums over the 10 years, however I have claimed over R75 000 in that time.

These procedures are nothing out of the norm, and range from 2 x child births, 4 sets of grommets, 2 tonsillectomies and the much-celebrated vasectomy.

Believe me when I say that I am at a quandary with celebrating this. I am most grateful that I did not have to personally cough up for these costs when they arose, while at the same time I am wondering how a policy that back in 2010 cost only R120 a month, would cover a shortfall of R15 000 in child birth. It seemed like it would take the Gap Insurance company years to recover the cost from my premium.

The main reason why Gap Cover came about was to counter the high charges that specialists were charging patients that were over & above the NHRPL’s tariff. However as soon as the market cottoned on to Gap, the specialists cottoned on even quicker. So, the product that was designed to cover the shortfalls invariably became the enabler of their ability to charge higher and higher fees. Long gone are the days where Gap tops you up by a mere 100 or 200%. Some Gap Policies cover you over and above 500%. There are now some specialists that charge well over 700% for the pleasure of doing business with them, which still leaves patients short after the medical aid coughs up their 100%, plus Gap’s 500%.

I then ask myself the question “If it was that easy to charge an extra R350 (2017 prices) per family for covering the Gap up to 600%, why don’t the medical aids just charge that little extra and get rid of the Gap companies?” Herein lies the conundrum, while there is a real need for Gap Cover, there is also a growing concern around how sustainable this short-term insurance product will be when the specialists are charging any rates they like without regulation or guidance. How much longer will we be able to afford the luxury purchase of the product that enables us to be overcharged?