As healthcare costs continue to rise in South Africa, medical aid schemes often fall short in covering the full extent of medical expenses. This gap can leave individuals and families facing significant out-of-pocket costs, especially during unforeseen medical emergencies. To address this concern, FNB offers a robust Gap Cover policy designed to cover these shortfalls, ensuring financial peace of mind for its customers.
Overview of FNB Gap Cover
FNB Gap Cover is an insurance policy tailored to cover the medical expenses that exceed what is paid by your medical aid. With monthly premiums starting at just R240.00, this policy offers an affordable solution to bridge the gap between what your medical aid pays and the actual cost of medical services. This cover is available exclusively to individuals over the age of 18 who are members of a registered medical aid scheme in South Africa.
Who is Eligible for FNB Gap Cover?
FNB Gap Cover is available to various members of a family, ensuring comprehensive coverage for dependents. Here’s a detailed breakdown:
- Primary Policyholder: The policy is primarily available to individuals over 18 who are members of a medical aid scheme.
- Spouse: A spouse who is also a member of a medical aid scheme can be covered under the same policy as the primary policyholder. The spouse is eligible for the same benefits as the main member.
- Children: Children can be covered under the plan until the age of 26, provided they are financially dependent on the main member. Special provisions are made for children with special needs, who can be covered for life if they are unable to support themselves financially due to a mental or physical disability.
- Special Dependents: FNB Gap Cover also extends to special dependents who may not be the plan holder’s children but are dependents under the primary policyholder’s medical scheme. However, coverage for special dependents is subject to the discretion of FNB.
Key Benefits of FNB Gap Cover
FNB Gap Cover offers a range of benefits designed to cater to various medical expense shortfalls. Here’s what you can expect:
- Coverage for Medical Expense Shortfalls: The primary benefit is the coverage for medical expense shortfalls. This includes shortfalls for services rendered by surgeons, radiologists, pathologists, and physiotherapists, both during hospitalizations and specified out-of-hospital events.
- Oncology Treatment Shortfalls: Given the rising costs of cancer treatments, FNB Gap Cover provides additional coverage for oncology treatment shortfalls, ensuring that policyholders are not burdened with excessive out-of-pocket expenses.
- Casualty Benefits: The plan also includes a casualty benefit, offering coverage for treatment received in casualty wards, which can be a significant relief in emergency situations.
FNB Gap Cover Plans in 2024
FNB offers three distinct Gap Cover plans, each catering to different needs and budgets:
- Essential Plan
- Comprehensive Plan
- Elite Plan
Let’s explore each in more detail:
1. Essential Plan
The Essential Plan is FNB’s entry-level option, providing coverage at 300% of the medical scheme rate for medical expense shortfalls. This plan includes a casualty benefit, with policyholders receiving up to R4,000.00 in cover per year.
- Coverage for Cancer Treatment: The plan also covers oncology treatment shortfalls at 300% of the medical scheme rate.
- Premiums: The Essential Plan starts at R240.00 per month for policyholders under 30, with additional premiums for dependents. For example:
- Age 30-54: R265.00 per month for family coverage, with an additional R27.00 for each dependent.
- Age 55-59: R308.00 per month, with R30.00 per dependent.
- Age 60-64: R365.00 per month, with R37.00 per dependent.
- Age 65 and over: R485.00 per month, with R50.00 per dependent.
2. Comprehensive Plan
The Comprehensive Plan offers enhanced coverage, with up to 500% of the medical scheme rate covered for medical expense shortfalls. This plan is ideal for those seeking more extensive protection against high medical costs.
- Coverage for Copayments: The Comprehensive Plan also covers up to 25% of the costs if cancer treatment expenses exceed the medical scheme’s limits.
- Premiums: Monthly family premiums for the Comprehensive Plan start at R350.00, with additional costs for dependents.
3. Elite Plan
The Elite Plan is the most comprehensive option offered by FNB, providing unlimited coverage for medical expense shortfalls. This plan covers various medical expenses and oncology treatments, with additional benefits for casualty ward services.
- Premiums: The Elite Plan starts at R415.00 per month. The plan covers the difference in treatment costs up to R50,000.00 and offers up to R20,000.00 in coverage for casualty ward services.
Advantages of FNB Gap Cover
FNB Gap Cover offers several advantages, making it a valuable addition to your medical aid plan:
- Multiple Plan Options: With three distinct plans, customers can choose the level of coverage that best suits their needs and budget.
- Fixed Premiums: The cost of gap insurance is fixed, allowing for predictable budgeting.
- Coverage for Dependents: Financially dependent children can be included in the plan, ensuring comprehensive family protection.
- Special Needs Coverage: The plan offers lifelong coverage for children with special needs, providing peace of mind for families.
Disadvantages of FNB Gap Cover
While FNB Gap Cover offers robust protection, there are a few drawbacks to consider:
- Limited Coverage for Dependents: The policy can only cover up to five people, which may be limiting for larger families.
- No Cash Back: Unlike some other FNB insurance products, the Gap Cover plan does not offer cash back on premiums.
Applying for FNB Gap Cover
Applying for FNB Gap Cover is straightforward. Applicants must be 18 years or older, have a valid South African ID, and be members of a registered medical aid scheme. Additionally, all lives covered under the plan must be included in the same medical aid scheme.
Conclusion
FNB Gap Cover is a comprehensive solution designed to protect individuals and families from the financial burden of medical expense shortfalls. With three distinct plans—Essential, Comprehensive, and Elite—customers can choose the level of coverage that best meets their needs and budget. While the cover may not be customizable, its fixed premiums, extensive benefits, and coverage for dependents make it a valuable addition to any medical aid plan.