How to Submit Your Gap Cover Plan

Once you’ve made the decision that you need gap cover, you need to investigate your options. Gap cover is there to pay the shortfall between what the healthcare provider charges and your medical aid is prepared to pay. Several service providers offer gap cover. Their products differ. Before choosing one, make sure you know what will and won’t be covered.

The gap cover claim process

Find out how much your medical aid will be paying. You need to be familiar with your medical aid’s payment structure and understand what they will cover for different procedures.

When you receive treatment, your healthcare provider will submit a claim to your medical aid. Once the medical aid processes the claim, they will pay their portion according to their tariff rates.

If there is a shortfall between what the provider charged and what your medical aid paid, this is where your gap cover comes in. You’ll need to submit a claim to your gap cover provider with the necessary documentation.

Required documentation

Typically, you’ll need to provide:

• A copy of the medical aid statement showing what they paid
• The original invoice from the healthcare provider
• Your gap cover policy details
• Any other supporting medical documentation

Processing time

Most gap cover providers aim to process claims within 48 hours to 5 business days, depending on the complexity of the claim and whether all required documentation has been provided.

Tips for smooth claims

• Keep all medical documentation organized
• Submit claims promptly after receiving treatment
• Ensure all forms are completed accurately
• Follow up if you haven’t heard back within the expected timeframe
• Keep copies of everything you submit

Understanding the claims process before you need it can help ensure a smooth experience when the time comes to use your gap cover benefits.