In the complex world of health insurance, the issue of gap coverage has become crucial for today’s consumers. As health plans increasingly include gaps, co-pays, and sub-limits, gap coverage provides essential financial protection against unexpected events. However, it is crucial to understand the in-depth understanding of how gap coverage works in order to choose the right one for your needs, budget, and health insurance plan.
There are some common misconceptions about gap coverage that are important to dispel in order to maximize your coverage.
**Myth 1: I have comprehensive health insurance, so everything is covered**
It is common to think that with high-end health insurance, all medical expenses will be automatically covered. However, even with expensive, comprehensive health plans, it is likely that you will encounter reimbursement gaps, as specialists often charge far more than the insurance rate for their services.
Even comprehensive medical plans can cover up to 300% of the health insurance rate, but it is common for some specialists to charge much more, sometimes up to 500% to 600% or more. This can result in significant financial gaps that you have to pay out of pocket, even with gap coverage that typically covers up to 600% of the health insurance rate. It is always best to get a cost estimate from a specialist in advance to make an informed decision.
**Myth 2: Gap coverage will cover my daily medical expenses**
It is essential to understand that gap coverage does not cover daily medical expenses. This is because gap coverage is designed to fill financial gaps encountered during a hospital stay and related expenses, including sublimits and co-payments.
Visits to the general practitioner, as well as optometry and general dentistry that are usually covered by health funds, are not included in gap coverage. However, some gap cover plans offer additional benefits, such as accident cover for emergency visits outside of GP opening hours.
**Myth 3: If my gap cover policy covers it, I can make a claim even if it’s not covered by my medical insurance**
Gap cover policies often offer extended cover for major illnesses such as cancer. For example, gap cover will cover financial gaps when the annual cancer benefit cap of the health insurance plan is reached.
However, gap cover will not cover anything that is not covered by medical insurance, even if it is a benefit listed in the gap cover plan. For example, your gap coverage policy may state that it covers gaps related to cancer biologic drug treatments. However, not all health insurance plans cover this and if your health insurance doesn’t cover it, neither will your gap coverage.
In conclusion, to maximize the effectiveness of your health insurance and gap coverage, it is essential to understand how they work and to ensure that your coverage is tailored to your specific needs. If in doubt, do not hesitate to consult a broker or financial advisor in order to benefit from their free expertise and guidance towards the best possible solution for you and your family.