What are my Shortfalls?
Medical Aids rarely meet 100% of a Specialist’s bill for an In-hospital procedure.
Most usually meet 100% of their own Medical Aid Rate, which in many instances is only equal to 1/3rd of the Specialist’s actual bill.
Hence we have packaged 6 benefit combinations that we believe are the most popular with our clients.
1. Tariff Gap @ R131 pfpm (per family per month).
(Health Rate Enhancer)
2. Tariff Gap Plus @ R192 pfpm.
(Health Rate Enhancer + Self-payment Protector)
3. Tariff Gap Cancer @ R198 pfpm.
(Health Rate Enhancer + Cancer Treatment Enhancer)
4. Tariff Gap Elite @ R240 pfpm.
(Health Rate Enhancer + Self-payment Protector + Cancer Treatment Enhancer)
5. Tariff Gap Supreme @ R283 pfpm.
(Health Rate Enhancer + Self-payment Protector + Cancer Treatment Enhancer + Hospital Sub-Limits Enhancer)
6. Tariff Gap Seniors @ R183 pfpm.
(Health Rate Enhancer 70+)
Benefit Descriptions:
Health Rate Enhancer (Tariff Gap) eliminates the shortfall between the actual cost of Specialist’s Bills for In-Hospital procedures and the re-imbursement rate applied by your medical aid up to a maximum of 500% of Tariff.
The Self-payment Protector benefit is equal to the charges levied by your Medical Aid in the form of any co-payments or deductibles, limited to R30 000 in aggregate per annum per insured, and R50 000 in aggregate per annum per family.
The Cancer Treatment Enhancer benefit is a benefit that will cover any shortfalls relating to limitations imposed by your Medical Aid for the treatment of cancer. Maximum of R200 000 in aggregate per annum per family.
The Hospital Sub-Limits Enhancer covers any sub-limits imposed by your Medical Aid for in-hospital admissions up to a maximum of R30 000 in aggregate per annum per family.