When it comes to your family’s health, selecting a specialist or hospital of your choice for your medical treatment can lead to unexpected out of pocket expenses, even if you are a member of a medical aid. 

“Families often face costs over and above what their medical scheme covers on admission to hospital for a medical procedure or for consulting their preferred specialist. Now, this doesn’t need to be a limiting factor when it comes to making decisions about what is best for you and your health,” says Teshlin Akaloo, managing director of NetcarePlus. 

“In many cases, unless people are willing to cover the costs above their medical scheme’s limits, they are restricted to the use of their scheme’s network of hospitals and doctors.”

Financial shock absorber

“Co-payments often can come as a shock at a time when a person should be focusing on their health. This points to the need for solutions that function as an extension to the cover medical schemes offer, providing security and the power of more choice in healthcare.”

Akaloo points out that medical specialists’ bills often exceed the amount medical schemes will cover. “It is important to understand that when medical aid benefit options refer to covering 100% of scheme rates for specialist consultations, this tends to be significantly lower than what the doctors’ services actually cost”.

“Cancer treatment can also become costly for families when medical scheme oncology benefit limits are reached or shortfalls occur when a patient chooses an oncologist who is not on their medical schemes network.”

To help fill these gaps NetcarePlus, which is part of the Netcare Group, has launched a gap cover product called NetcarePlus GapCare which provides access to a much wider choice of healthcare providers. The product is underwritten by the Hollard Insurance Company Limited.

Akaloo adds: “As NetcarePlus, we have created a solution that in addition to traditional gap cover benefits, enables full access to Netcare’s facilities regardless of the medical scheme plan you are on.”

More choice, more affordably

When medical care is required, this innovative gap cover range goes beyond the limits of a typical medical scheme, offering extensive shortfall cover such as for consulting in and out of hospital specialists, emergency medical treatment in an emergency department, extended day to day costs when medical savings have run out or benefit limits are reached. 

“Furthermore, medical schemes may apply sub-limits for certain in-hospital medical procedures, prosthetic devices, and extended stays in a mental health, rehabilitation, step down or sub-acute facility. Once the sub-limit is reached, NetcarePlus GapCare takes care of shortfalls” Akaloo adds.

This holistic gap cover offering leads the market in terms of the breadth of services covered. “For example, witnessing or surviving a violent crime or accident or experiencing a trauma, such as yourself or a loved one being diagnosed with a life threatening illness, can happen to anyone at any time and can have lasting consequences for mental health if the person does not have sufficient professional support early on,” Akaloo says.

“We have therefore made sure that a trauma counselling benefit is included on all NetcarePlus GapCare options to ensure counselling with a registered counsellor or psychologist is provided for over and above medical savings and medical scheme sub-limits.” 

More gap benefits, more widely available

These benefits are not restricted to the use of Netcare hospitals, as shortfalls in any hospital will be covered. 

For those looking to start or grow their family, the NetcarePlus GapCare 300+ and 500+ options provide cover against shortfalls for both prenatal and postnatal costs, including in the case of high risk pregnancies. “If your medical scheme only covers a stay in the general maternity ward, we cover the ‘gap’ for mothers to stay in a private room where availability permits, offering more privacy for the new parents,” Akaloo adds. 

Now available directly to medical scheme members

Introduced late last year, the NetcarePlus GapCare range was previously available through intermediaries and is now also being made available directly to individuals via an e-commerce platform on the Netcare website, where the sign up process can be concluded within minutes. 

Securing private healthcare affordably 

Commenting on the introduction of NetcarePlus GapCare, Besa Ruele, chief executive officer of Hollard Life Solutions, said: “We are pleased to be a part of this innovative answer to reducing the medical funding challenges many South Africans grapple with. NetcarePlus products offer a practical and affordable solution, providing reassurance that access to private healthcare is secured in advance – before it is needed.”

“Access to quality healthcare is important for all of us. As a company at the forefront of developing solutions that mitigate against life’s unexpected eventualities, we are acutely conscious of the importance of preparing for the challenges that life throws our way,” Ruele says.

“Life can be unpredictable, but healthcare costs don’t have to be. Taking care of your family’s medical needs in world class hospitals and with the specialists of your choice can be achieved without threatening household budgets. This is the new, affordable way to be assured of private healthcare cover for your family well beyond the limits of your medical scheme,” Akaloo concluded.



For more details visit https://www.netcare.co.za/NetcarePlus/Gap-Cover. 

Note: The NetcarePlus GapCare product is underwritten by The Hollard Insurance Company Limited (Hollard), a licensed non-life insurer and an authorised financial services provider. NetcarePlus is an authorised financial service provider. This cover is not a medical scheme, and the cover is not the same as that of a medical scheme. This insurance product is not a substitute for medical scheme membership.