What are the top 5 most-common Gap cover claims?

Fascinating stats from Turnberry’s claims department show just when Gap Cover comes in handy.

Even the most comprehensive Medical Aids won’t foot the bill for every procedure, hospital stay, treatment or specialist fee. To ensure you’re not left out-of-pocket, selecting the right Gap Cover for your needs helps to cover you in the case of medical expense shortfalls.

But Gap Cover is certainly not only needed for rare dread diseases or exceptional circumstances. In fact, the most common claims are for conditions that affect a large number of South Africans.

Let’s take a look at the top 5 types of claims that Turnberry processes for its members:

Caesarean sections (average claim value = R6 797.57)  

As an increasing number of women opt for caesarean sections as their preferred delivery approach, the longer hospital stays have placed pressure on Medical Aid schemes. Added to this, input costs for the gynaecological profession have skyrocketed in recent years (malpractice insurance, for instance, has surged 925% in the past 8 years). The result is that fewer gynaecologists are practising obstetrics these days, pushing up the prices for consumers and Medical Aids.

Gap Cover comes in as a very handy way to help cover these medical expense shortfalls, as families welcome new life into their home.

Gonarthrosis (average claim value = R7 072.11)  

Gonarthrosis (osteoarthritis of the knee) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. Individuals with this surprisingly common condition often find that their Medical Aid requires a co-payment, which should be served by your Gap Cover policy.

Breast cancer (average claim value = R4 842.69)

Cancer can have devastating emotional and financial consequences for affected individuals and families. Some statistics suggest that breast cancer affects as many as 1 in 8 women, and it certainly impacts the lives of millions of South African women. Your Gap cover should come to the rescue for medical expense shortfalls for the likes of radiotherapy, chemotherapy, surgeries, mastectomies, reconstructions and biological cancer treatments like Herceptin.

While the average claim value looks relatively low it needs to be taken into account that you could be required to pay this amount monthly to your healthcare providers should your medical aid benefits be depleted. 

Impacted wisdom teeth (average claim value = R2 861.07)

Consider that dentistry often isn’t comprehensively covered by your Medical Aid scheme. For dental and maxillofacial surgeries, Gap Cover often helps to ensure customers are not left out-of-pocket.

Rotator cuff injury (average claim value = R6 261.30)

This injury in the shoulder joint tendons and ligaments makes the list of our top 5 most-common claims. Not only do the orthopeadic bills tend to run way over what Medical Aids are willing to pay, but the anaesthetist bills often catch consumers by surprise. Whether or not you’re an active, sporty type, it’s important to ensure you have the right Gap Cover policy to cover this type of injury.

Though we certainly hope to avoid any of these 5 conditions during the course of our lives, the reality is that these 5 are alarmingly common among many South Africans. As you consider yours and your family’s medical cover needs, chat to your broker or financial advisor about how to best select the Gap Cover policy to suit your needs.

By | 2018-08-09T09:03:23+00:00 March 24th, 2018|News|