It is extremely important that medical aid members understand co-payments in order to avoid costly surprises. Medical aid plans have to have limits in place to control their business, calculate monthly contributions and avoid abuse.
Private hospitals and specialists are free to charge what ever amount they choose for their procedures and services. As a result, the amount is charged is often significantly more than the amount the medical aid scheme actually pays. This shortfall will have to be paid by the member out of pocket in what is known as a co-payment.
Do not think these amounts are small and insignificant, in many cases, they can be very high. If you need multiple treatments or procedures this could lead to financial distress if not budgeted or planned for. A lack of understanding often leads to an unpleasant shock when bills for co-payments start piling up.
The important thing is to be aware of co-payments in advance. They are good in that they keep the monthly cost of your medical aid down and make it more affordable. Do some homework as to what the medical aid scheme pays for specific procedures and specialists versus the actual costs of these treatments. In some cases, you can shop around but when it comes to you or your families health, you want to know you are getting the best possible treatment. Many people mistakenly assume that because their medical aid says they cover 100 percent (or in many cases, a much higher percentage) that they will not be liable for any additional costs. This is not the case.
Fortunately, there is a solution. Gap cover is available to make up for the shortfall. You can elect to take additional cover that will provide for shortfalls where co-payments are required. You would need to do a bit of research and give some thought to your families medical history as well as make allowance for the unexpected. Look at gap cover to avoid any expensive surprises and have peace of mind when you need it most.