ORDHealth Tailored Elite Gap Cover & Disovery Health Medical Aid Does Not Have Waiting Periods For Members  When Employer Groups Sign Up.

Gap Cover are policies deemed as short-term and are designed to cover shortfalls that you would have otherwise had to pay when billed by medical service providers. 

Similar to medical aid, gap cover does not cover all and any procedures, but it does cover most procedures and acts as a top up to what your current medical aid would have paid. 

It is important to choose your medical aid wisely before getting gap cover, since each medical aid scheme has their own health rates what they would pay, choosing a medical aid that has low health rates may render your gap cover less efficient. 

Gap cover comes in all shapes and sizes, and ORD Health has worked out a special concession with leading Gap provider, Stratum Benefits, to give you a 500% boost on your medical aid. 

A working example of how Gap cover works in a very basic sense is:

If your medical service provider charges R500 for a procedure and your medical aid health rate for that service is R75 and covers only 100% of the health rate, you would have a R425 shortfall.

If your medical aid has a 200% health rate cover, they would cover R150 leaving you with a shortfall of R350

Gap cover comes in with 300% (depending on your option you have chosen) and matches your medical aid provider’s health rate meaning they would pay R225 on top of what the medical aid has paid.  So at a 100% medical aid and 300% Gap cover, you would still owe R200,

or at a 200% rate and 300% gap cover, you would owe R125.

It is important that you take note of two things from this example: 

  1. Medical service providers can charge ultimately what they want, so try to get quotes as far as possible before going to just any provider. 
  2. Whilst medical aid premiums must remain the same for every individual regardless of age or lifestyle according to law, they are not regulated in how much they need to pay for certain services. Research your medical aid carefully before accepting, or review your current medical aid by look at what their Health Rates would be for your most common procedures

Absolutely, if anything it’s an absolute necessity. The only time where people debate the ‘worthiness’ of Gap cover is when they fail to research the costs of their procedures before hand or choose medical aids that already has a low health rate. 

Remember, in emergencies your medical aid must pay in full to stabilize you or a member on your medical aid. Any procedures after that might be subject to the health rates they have set.

Since Gap Cover is deemed as short-term insurance policies, they are not tax-deductible or subject to tax credit like medical aid would be.

Yes, there is a 3-month waiting periods just like with medical aid, and a 12-month waiting period for any pre-existing condition cover.

When moving from one gap cover option to another, you will only have a waiting period on the benefits you did not have in your previous option of gap cover.