December is a time for relaxing, spending time with family and friends and generally enjoying the festivities of the season. However, accidents happen all too frequently, and it’s not called the silly season for nothing. Even with Medical Aid in place, medical expense shortfalls in the event of accidents and emergencies can run into thousands of Rands. So, before you slap on your sunscreen, slip into your flip flops and head off on a well-deserved holiday break, make sure your gap cover is in place for 2019. This will help to ensure your New Year doesn’t start with unpleasant and unanticipated additional medical expense shortfalls.
Starting the New Year
January is often a lean month, to begin with, as salaries are paid for a number of people in mid-December and need to see people through until the very end of the following month. Starting the New Year in with the additional pressure of a large medical expense shortfall is an unnecessary and entirely avoidable scenario. Gap cover can save you from these out of pocket medical expense shortfalls in the case of an accident or emergency,
During the festive season, there is always a huge increase in the number of motor vehicle accidents on our roads. Unfortunately, injuries sustained as a result of a motor vehicle accident are often serious and require extensive medical treatment. They are also typically emergencies, and are treated at the nearest hospital, whether or not this hospital is a Designated Service Provider (DSP) in your medical scheme’s network. While treatment for life-threatening injuries resulting from an accident is covered as a Prescribed Minimum Benefit (PMB), the full cost of a hospital admission may not be covered once a patient is stabilised. If you do not have gap cover in place, you will be liable for the remainder of the bill, which could add up to a significant sum.
However, it is not only motor vehicle accidents that you need to worry about. Over the festive season, many people take advantage of the holidays to enjoy new adventures or take up new pursuits. From hiking to surfing, parasailing to cycling and even running, injuries are all too common and once again could result in significant medical expenses without gap cover to take up the medical expense shortfall.
Even accidents at home, such as burns and cuts while cooking or broken bones from a fall, might require a visit to the emergency room, potentially after hours, which can be an expensive undertaking. These expenses are often considered to be ‘out of hospital’ and are usually covered under day-to-day medical expenses, therefore they are most often funded from medical savings of your medical scheme. At this time of year, however, many people have no medical savings left. Certain Gap Cover offerings provide a casualty benefit, which comprehensively covers facility fees, consultations, medications, radiology and pathology associated with an accident.
Check your car; check your medical aid and gap cover
We all know that before we embark on a long trip in the car, we need to take the vehicle for a full safety check. To ensure full coverage over the season and for the year ahead, we need to do the same for our Medical Aid scheme and Gap Cover. It is essential to evaluate your current Medical Aid plan and how it performed according to your needs over the past year. If it needs to be upgraded, or you wish to downgrade it, then that decision must be made now with your financial advisor. Any changes to your medical aid plan needs to be submitted before the end of the year and it’s important to contact your medical aid to find out when the cut off date is, but in reality, once the holidays start this is the furthest thing from anyone’s mind.
If your plan is going to be changing your medical scheme, it is also essential to ensure that any Gap Cover you have in place aligns with your new plan and policies. It is important to remember that gap cover can only provide cover for shortfalls of incidents and conditions that are covered by your Medical Aid. If your Medical Aid does not cover it, your Gap Cover cannot either, even if it is included in the Gap Cover bouquet.
Brokers know best
Talk to your financial advisor about ensuring your Medical Aid meets your needs, and your Gap Cover aligns with and effectively augments this cover. Check how your premiums will increase in January and ensure you have budgeted for this expense to make sure you are covered. If you haven’t made the correct choice of medical cover for 2019, or you forget to make any changes you need to, you will be paying for that decision for the rest of the year. It is best to have this sorted out before the holidays begin, so you can enjoy your festivities to the full.
By Tony Singleton, CEO at Turnberry Management Risk Solutions