Zimpapers Logo

Taurai Craig Museka
MEDICAL aid is universally and correctly considered as one of the most important types of insurance primarily because it is good health that preserves life.

A decent medical aid is a must-have considering that we all fall sick at some point. Getting a medical aid that fits your needs is quite difficult considering that there is an interfusion of two fields that are really great with specialised language. On one end you will find yourself in the unpleasant world of medical terms and on the other hand you are confronted by insurance jargon.

While you are buried in all these terms you still need to know what exactly is covered by your medical aid lest you be met by the most talked about topic in medical aid (shortfalls). A lot of us assume that our medical aid will cover all medical costs we encounter.

The greatest surprise comes when we are told we have to pay a medical expense that we thought was covered by our medical aid. I have seen a lot of commentators in the local media trying to blame shortfalls on expensive private doctors or untransparent medical aid societies, but truth of the matter is medical aid shortfalls are not only a Zimbabwean issue but a global concern.

Countries like Canada have medical care systems that are envied world over for providing cover that exceeds most countries but still their medical insurance systems do not cover every cost.

It is for this reason that gap insurance was created. The fact that this type of insurance is found all over the world shows you that medical aid shortfalls are not only a local problem.

Gap insurance is a medical insurance product that is purchased by members of medical aid schemes to cover for cost of in hospital specialist consultations and procedures that are not covered by medical aid payouts.

The cover usually extends to the spouse and dependants of the medical aid member. Some specialists, surgeons and medical care providers charge in excess of what medical aid schemes set to pay.

This then means that the medical aid members are left with shortfalls to pay for these services they would have received.

This will obviously be a burden on their pockets considering sickness is never planned for and the only available plan would be that ‘insufficient’ medical aid.

Gap insurance cover is not only a protection from debts you could incur from unexpected medical expenses but it also gives you freedom to consult specialist and have procedures such as orthodontic surgery, urology, cardio surgery, gynecological surgery, neurosurgery, appendectomy, hernia surgery and advanced radiology without fear of exceeding your medical aid limit.

It is also common for chronic patients to exceed their annual hospitalisation limits as prescribed by their medical aid. Gap insurance gives them that additional cover in the event that they exceed this limit.

We have to commend insurance service providers for introducing products like gap insurance into the market. However, making these products affordable for all is still an issue especially considering money is tight for everyone and we are cutting down on spending. You should not take chances with your medical needs though, especially if you are a bit older and suffer from chronic conditions.

Don’t be shy to ask your medical aid provider what your medical aid covers especially before you are admitted into hospital or before you consult specialist doctors.

Be humble enough to use Government facilities if you have to or check into facilities less expensive than those your heart desires. I know some medical aid societies have their own facilities that have surgeries and laboratories, which you could also take advantage of.

However, living a healthy lifestyle is the best way to cover the gap on your medical aid. Strive to have consciousness and make choices towards a healthy and fulfilling life.

The World Health Organisation defines wellness as a state of complete physical, mental, social well-being and not merely the absence of disease or infirmity.

It is absolutely crucial to maintain a level of wellness in order to relief ourselves from stress, subdue diseases and ensure fruitful interactions.

This is why we are seeing innovative products from medical aid societies such as iGo by Cimas, which are concerned with wellness of members and encouragement to live healthy lifestyles.

Taurai Craig Museka is a freelance writer with interest in insurance. Send feedback to [email protected] / whatsapp +263775608014