New rules restrict gap-cover benefits
There is no regulation of what doctors can charge or how much your scheme should pay, leaving potentially unlimited liabilities on consumers for medical shortfalls
Short-term insurers have been offering medical scheme members policies that top up their medical scheme cancer benefits, but regulations have changed the benefits that can be offered - and your cover may change even if you have an existing policy. Regulations under the short- and long-term insurance acts introduced changes for new policies covering health events from April 1 this year. Existing policies will have to conform with the regulations when they are renewed. For many people this will be from January 1 next year. A key change is that benefits on policies offering cover for shortfalls between what your doctor charges you and what your scheme pays, and any shortfalls in benefits, such as cancer benefits, are now limited to R150,000 per insured person on the policy, says Mike Settas, MD at Kaelo Xelus. These policies will now be known as medical expense shortfall policies. The new regulations prevent insurers from setting an entry age limit and restrict insurers to charging the...
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