Regarding your health, getting the right cover to meet your needs can be confusing when you have the options of medical aid, gap cover, and illness insurance which covers severe illnesses not limited to cancer, a stroke, or a heart attack. We’ve tried to simplify the benefits and purpose of each product to make it easier for you to make a more informed decision when co-creating a plan with your adviser.

Your medical aid provides cover towards the cost of diagnosis and treatment costs of an illness. However, it won't cover any indirect costs you incur because of suffering an illness. Gap cover is intended to provide cover towards the shortfall of treatment costs not covered by your medical aid. It's insurance specifically designed to supplement your existing medical aid cover.

Then there’s illness insurance, also known as dread disease insurance, critical illness cover, or severe illness cover. This is insurance that provides cover for illnesses, like cancer or a stroke, that may carry a high risk of death or negatively impact your quality of life and ability to perform daily activities. Illness insurance can pay towards ongoing expenses such as rehabilitation costs, travel costs to treatment centres, and modifications to your home or car.

How does medical aid work?

1. You must have an active membership with a registered South African medical aid scheme.

2. Each medical aid decides what it will pay or the amount of cover it will grant for the medical procedures covered. Your medical aid is intended to provide cover towards the cost of diagnosis and treatment of a severe illness.

3. Costs are paid directly to your service provider in accordance with the rules of your medical scheme.

How does gap cover work?

1. You must have an active membership with a registered South African medical scheme to take up gap cover.

2. What does gap cover pay for? If the treatment is provided by a practitioner that charges more than the medical aid rate, your gap cover will make payments towards the portion of your bills not covered by the medical aid. However, the policyholder will be liable to settle the bill in full upon consultation or procedure. Thereafter, they will claim the excess amount from their gap cover, which will then be paid/settled directly with them.

Learn more about Old Mutual Gap Cover.

How does illness insurance work?

1. Illness insurance pays you a specified percentage of the cover amount as a tax-free single amount when you are diagnosed with a severe illness covered by the policy.

2. You need to take out illness insurance with a reputable insurance company such as Old Mutual.

Learn more about Old Mutual Illness insurance.

Do I need all these products?

Each product can help support you financially when the unexpected happens such as a cancer diagnosis, heart attack, or stroke. Where medical aid may have a shortfall to cover the full costs, you can always lean on your gap cover or illness insurance. The cost of quality medical care for major life-threatening diagnoses and procedures can be astronomical. Associated expenses can devastate your finances and therefore you need to be covered adequately during diagnosis and treatment for these diseases. Having the payout from illness insurance can help you take the time to recover from your disease without having to worry about money. Knowing you're adequately covered can protect your family against the financial consequences.

If all this information seems overwhelming, you can chat with one of our friendly and accredited financial advisers. They're here to help you choose the right cover for you.