Do you have the right combination of medical aid and gap cover to ensure your clients are effectively protected?
28 Mar, 2024

James White, General Manager, Sales and Marketing at Turnberry



With rising inflation, an ongoing cost of living crisis and ever-increasing medical aid shortfalls, sub-limits and co-payments, it has never been more important to ensure that you tailor the best solution to meet your clients’ needs. Gap cover has become an essential addition to any comprehensive portfolio to protect clients’ financial and physical wellbeing, but it is essential to match the right medical aid with appropriate gap cover. This involves considering multiple factors as well as cultivating an in-depth understanding of clients’ unique needs, lifestyles, and life stages.


What are the benefits


When it comes to gap cover, the products are all very similar – especially the top of the range offerings. While the differences between the offerings are often slight, there are pros and cons to each, especially around value-added benefits.


These may include things like a casualty benefit, cash payout on diagnosis of a dread disease, payment for medical aid and gap cover premiums for certain periods following the death of the main member, additional cancer cover, additional cover for scopes and scans, and international travel benefits, to name a few.


Things to look for


Regardless of value-added benefits, there are three elements that are essential to examine. These are medical expense shortfall cover, co-payment cover and sub-limit cover, as these make up around 90% of the shortfalls that clients will experience. It is also important to consider pricing and the services around the cover.


From an administrative perspective, the easier it is to onboard clients, submit claims and get them processed, and deal with queries, the less work it will be for brokers to deal with. The service is the key differentiator between gap cover providers, and it is something brokers should always bear in mind when selecting policies and cover for their clients.


It starts with medical aid


While gap cover is important, and arguably vital in today’s economic climate, it is essential, from the outset, to firstly ensure that medical aid cover is adequate for a client’s needs. Gap cover is exactly what it says – gap cover – and will only cover clients for the gaps or areas where their medical aid falls short.


This means that even if a comprehensive gap cover policy is selected, with extensive cover for cancer, scopes, scans and so on, if the medical aid does not cover the treatment, gap cover will not pay for it either. It is very important that brokers firstly ensure the medical aid option is the most appropriate for their client, and then align gap cover with this to create an effective financial shield.


Understand the clients and their needs


To ensure clients have the right combination of medical aid and gap cover, brokers need to find the right fit for their lifestyle, life stage, health profile, budget and more. This requires a comprehensive needs analysis on the client and the ability to cultivate a relationship with them to understand their requirements, as well as an in-depth understanding of the industry and the offerings available. Gap cover should be the final piece of the puzzle that slots in to complete a comprehensive umbrella to protect clients from medical expense shortfalls.







@James White, Turnberry Management Risk Solutions
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