Dear Colleagues
SANLAM GAP COVERS AN ADDITIONAL 500%
A Tariff shortfall is the difference between what your Medical Scheme pays and what your Specialist charges
Core Benefit Tariff Shortfall Example
Mr S is on a Medical Scheme – plan A, which covers him to a maximum of 100% of the Medical Scheme Rate.
This means that the Medical Scheme will pay all expenses towards Mr. S’s treatment costs.
The Medical Scheme Rate for a total colonoscopy is R2 000 (100%) which means that the maximum that the Medical Scheme will pay is R2 000 (100%).
The specialist performing the procedure charged R10 000 which is five (5) times the Medical Scheme tariff (500%).
The maximum Benefit payable by this policy for this procedure is therefore: R10 000 – Fee charged by the specialist LESS R2 000 Benefit paid by Medical Scheme equals to a total of
R8 000 funded by Sanlam Gap Cover
Sanlam Gap Cover Comprehensive Cover made Simple for you.
Benefits relating to this clause will only be paid in respect of services occurring during a Hospital Episode that are rendered and charged for by an individual Medical Practitioner.
The Sanlam Gap Team