Discovery Insure has launched a gap-cover policy for members of schemes administered by Discovery Health.
The move comes after many years of the administrator attempting to cushion members of Discovery Health Medical Scheme (DHMS), and other Discovery-administered schemes, from the effects of out-of-pocket payments by setting up networks of specialists who are contracted to charge at scheme rates.
Gap cover provides cover when a specialist treating a medical scheme member in hospital charges more than a medical scheme’s rates.
Discovery offers cover on its options at either 100 or 200 percent of Discovery Health rates, but in-demand specialists charge anything up to 600 percent.
Discovery Insure’s gap-cover policy will pay an additional 100 percent above the rate at which your option pays. In other words, if your scheme pays 100 percent of the DHMS rate, the gap-cover product will pay your bill between 100 and 200 percent of the DHMS rate.
The policy has an extender benefit that provides unlimited cover for specialists’ bills, but this pays out only at the end of the year and excludes an excess that depends on the option to which you belong. The policy also provides cover up to R100 000 for shortfalls on cancer-related claims. Premiums start at R100 a month.
It is expected that gap-cover products will in future have to comply with regulations designed to ensure that health insurance policies do not undermine medical schemes. Draft regulations have proposed a R50 000 limit per claim, but the final regulations will be released only once a policy is in place for low-cost medical scheme options.