Top 5 Common Gap Cover Claims

The most common Gap cover claims are for conditions that affect many South Africans. Those who do not have gap cover can suffer serious financial consequences when undergoing treatment for these common issues which often come at a high cost.

1. Rotator Cuff Injury

One of the most common Gap cover claims is for a rotator cuff injury. The rotator cuff can become damaged if there has been a trauma to the shoulder but it can also occur with age. The treatment often requires surgery by an orthopedic specialist, and these specialists typically charge well above medical aid rates.

2. Knee Surgery

Knee injuries and conditions requiring surgery are extremely common, especially among active individuals and older adults. Procedures like arthroscopy, ligament repairs, and knee replacements can result in significant gaps between specialist charges and medical aid payments.

3. Cardiac Procedures

Heart-related procedures, including angioplasty, stent placement, and bypass surgery, are among the most expensive medical treatments. Cardiologists and cardiac surgeons often charge premium rates, making gap cover essential for these procedures.

4. Cancer Treatment

Oncology treatment is one of the most significant areas where gap cover proves invaluable. Chemotherapy, radiation therapy, and surgical oncology procedures can result in substantial shortfalls. Many gap cover policies offer enhanced oncology benefits specifically for this reason.

5. Childbirth and Caesarean Sections

Maternity care, particularly caesarean sections, is a common source of gap cover claims. Obstetricians and anesthetists often charge above medical aid rates, and the costs can add up quickly when you factor in the surgeon, anesthetist, and hospital fees.

Protecting Yourself

These common procedures demonstrate why gap cover is so important. Even with comprehensive medical aid, you could face significant out-of-pocket expenses for routine medical care. Gap cover ensures you’re protected when you need medical treatment most.