1 00:00:00,200 --> 00:00:03,519 Speaker 1: So many of us have been told that gap cover 2 00:00:03,800 --> 00:00:07,600 Speaker 1: is essential to have in order to avoid those big 3 00:00:07,680 --> 00:00:10,080 Speaker 1: out of pocket medical bills, and as I said earlier 4 00:00:10,080 --> 00:00:12,399 Speaker 1: in the show, that's certainly what I was told by 5 00:00:12,400 --> 00:00:15,760 Speaker 1: my financial advisor several years ago. I didn't have gap cover, 6 00:00:16,160 --> 00:00:18,400 Speaker 1: I think largely because I didn't really understand what the 7 00:00:18,440 --> 00:00:20,479 Speaker 1: product was, and then there was probably a bit of 8 00:00:20,520 --> 00:00:23,799 Speaker 1: me that just felt a bit aggrieved that I ought 9 00:00:23,800 --> 00:00:27,160 Speaker 1: to now have another product to fill in the gap 10 00:00:27,320 --> 00:00:30,240 Speaker 1: of the existing product that I felt I was paying 11 00:00:30,280 --> 00:00:32,920 Speaker 1: through the nose for. I'm sure I can't be alone 12 00:00:32,960 --> 00:00:35,199 Speaker 1: on that in that, but I have been on a 13 00:00:35,240 --> 00:00:39,559 Speaker 1: gap cover plan ever since, and personally for me, I found. 14 00:00:39,360 --> 00:00:40,239 Speaker 2: It very useful. 15 00:00:40,760 --> 00:00:43,879 Speaker 1: Two babies later and an unexpected ton select me in 16 00:00:44,000 --> 00:00:48,680 Speaker 1: twenty twenty one, and it has helped. It's meant to 17 00:00:48,720 --> 00:00:50,760 Speaker 1: protect you, of course, when there is a gap in 18 00:00:50,800 --> 00:00:55,000 Speaker 1: what your medical scheme pays, but the reality is a 19 00:00:55,000 --> 00:00:57,960 Speaker 1: bit more nuanced, and some experts say that not everyone 20 00:00:58,200 --> 00:01:01,760 Speaker 1: necessarily needs it, and that in some cases upgrading to 21 00:01:01,800 --> 00:01:05,880 Speaker 1: a more comprehensive medical scheme option could offer similar protection. 22 00:01:06,600 --> 00:01:08,640 Speaker 1: But I think it's one of those things when it 23 00:01:08,720 --> 00:01:13,160 Speaker 1: comes to taking care of ourselves and our families in 24 00:01:13,200 --> 00:01:16,440 Speaker 1: the healthcare space, that there are lots of questions unanswered, 25 00:01:16,480 --> 00:01:20,000 Speaker 1: and so joining us to answer those questions, hopefully for 26 00:01:20,200 --> 00:01:22,759 Speaker 1: our sort of gap cover. One oh one this morning, 27 00:01:22,800 --> 00:01:25,399 Speaker 1: somebody that I haven't spoken to for years. Delighted to 28 00:01:25,400 --> 00:01:28,679 Speaker 1: welcome you back to the show, Financial Election and financial journalist, 29 00:01:28,720 --> 00:01:30,240 Speaker 1: my official French My good morning. 30 00:01:30,240 --> 00:01:31,120 Speaker 2: Good to have you with us. 31 00:01:32,080 --> 00:01:34,320 Speaker 3: Yes, good morning, and a great topic. It's one that 32 00:01:34,400 --> 00:01:36,640 Speaker 3: I think people are very interested in. So yeah, I 33 00:01:36,680 --> 00:01:37,960 Speaker 3: think we're gonna have a good conversation. 34 00:01:38,120 --> 00:01:38,840 Speaker 2: Yeah, I agree. 35 00:01:39,040 --> 00:01:42,240 Speaker 1: Let's start then with the basics. What is it, What 36 00:01:42,400 --> 00:01:45,479 Speaker 1: is gap cover, and what problem is it designed to solve. 37 00:01:46,640 --> 00:01:48,960 Speaker 3: I think what's very important to understand is that gap 38 00:01:49,000 --> 00:01:52,040 Speaker 3: cover only works in conjunction with a medical scheme. So 39 00:01:52,080 --> 00:01:54,000 Speaker 3: it's not something that you can buy as a separate 40 00:01:54,040 --> 00:01:56,760 Speaker 3: product if you don't have a medical scheme. 41 00:01:56,800 --> 00:01:57,880 Speaker 4: So your medical scheme. 42 00:01:58,600 --> 00:02:00,960 Speaker 3: The whole point of gap cover is covers what your 43 00:02:00,960 --> 00:02:03,200 Speaker 3: medical scheme doesn't pay for. 44 00:02:04,080 --> 00:02:06,720 Speaker 4: And I think this is a bit of a misunderstanding. 45 00:02:06,760 --> 00:02:08,760 Speaker 3: So people think, oh, I can take our gap cover 46 00:02:08,840 --> 00:02:10,680 Speaker 3: and I don't need to have a medical aid, But 47 00:02:10,760 --> 00:02:13,480 Speaker 3: that's not at all. It is simply, it pays in 48 00:02:13,600 --> 00:02:17,240 Speaker 3: a shortfall. So that's really what it is. And it 49 00:02:17,280 --> 00:02:21,639 Speaker 3: has become very popular partly because we see many specialists 50 00:02:21,720 --> 00:02:25,120 Speaker 3: now charging well above what a medical scheme will pay. 51 00:02:25,160 --> 00:02:28,040 Speaker 3: So medical schemes will say we have a specialist rate 52 00:02:28,080 --> 00:02:30,600 Speaker 3: of you know, we'll pay up to two hundred percent 53 00:02:30,720 --> 00:02:33,360 Speaker 3: of the schemes rate for the specialist, but the specialist 54 00:02:33,400 --> 00:02:34,680 Speaker 3: is charging four hundred percent. 55 00:02:35,040 --> 00:02:36,080 Speaker 4: So people have been going. 56 00:02:35,880 --> 00:02:38,760 Speaker 3: To hospital discovering that their bills are not fully paid. 57 00:02:39,040 --> 00:02:42,040 Speaker 4: And this is really what the gap cover is meant 58 00:02:42,120 --> 00:02:42,360 Speaker 4: to do. 59 00:02:42,919 --> 00:02:45,239 Speaker 2: And is this for inpatient outpatient? 60 00:02:45,280 --> 00:02:47,440 Speaker 1: I mean, if I've got, you know, a dodgy dodgy 61 00:02:47,440 --> 00:02:49,160 Speaker 1: foot or something and I need to go and see 62 00:02:49,320 --> 00:02:52,400 Speaker 1: somebody about that. And as you say that there is 63 00:02:52,440 --> 00:02:55,840 Speaker 1: that gap to pay, is it going to cover, for example, 64 00:02:55,919 --> 00:02:59,560 Speaker 1: a consultation or is it going into hospital as an 65 00:02:59,600 --> 00:03:01,000 Speaker 1: inpai and having surgery. 66 00:03:02,480 --> 00:03:06,720 Speaker 3: Yeah, so it is primarily for hospitalization. So some again 67 00:03:06,919 --> 00:03:09,040 Speaker 3: you've got to look at your plans. Some plans may 68 00:03:09,120 --> 00:03:12,560 Speaker 3: say they may include to out of hospital specialists visits 69 00:03:12,560 --> 00:03:14,240 Speaker 3: a year, for example, so you need to look at 70 00:03:14,240 --> 00:03:18,680 Speaker 3: your scheme. But it is primarily there for hospitalization, not 71 00:03:18,840 --> 00:03:23,160 Speaker 3: really for out of hospital illness, out of hospital procedures 72 00:03:23,440 --> 00:03:24,200 Speaker 3: or specialists. 73 00:03:25,240 --> 00:03:27,639 Speaker 1: Why is there this gap though? And I suppose that's 74 00:03:27,639 --> 00:03:30,240 Speaker 1: a conversation we could have forever. But so many medical 75 00:03:30,240 --> 00:03:34,880 Speaker 1: professionals in South Africa are charging above medical scheme rates 76 00:03:34,880 --> 00:03:39,200 Speaker 1: that create that gap in the first place. Is it 77 00:03:39,240 --> 00:03:41,920 Speaker 1: a situation, you know? And I imagine that's always going 78 00:03:41,920 --> 00:03:42,240 Speaker 1: to happen. 79 00:03:42,320 --> 00:03:43,480 Speaker 2: The medical the. 80 00:03:45,040 --> 00:03:47,640 Speaker 1: Health consultants will keep going up, and the medical aid 81 00:03:47,640 --> 00:03:49,200 Speaker 1: will keep going up, but there's always going to be 82 00:03:49,200 --> 00:03:50,080 Speaker 1: this gap in the middle. 83 00:03:50,080 --> 00:03:51,000 Speaker 2: I would imagine. 84 00:03:53,240 --> 00:03:56,560 Speaker 3: It's been very interesting to watch Sarah Jane to see 85 00:03:57,000 --> 00:04:01,440 Speaker 3: how specialists costs have increased as gap cover has been introduced. 86 00:04:01,480 --> 00:04:03,440 Speaker 3: And I'm going to be maybe a little bit controversial, 87 00:04:03,840 --> 00:04:06,720 Speaker 3: but I do think to some degree gap cover is 88 00:04:06,760 --> 00:04:09,800 Speaker 3: pushing up specialist costs because I don't if you've ever 89 00:04:09,840 --> 00:04:13,360 Speaker 3: been to see a specialist having a procedure that you 90 00:04:13,440 --> 00:04:17,400 Speaker 3: have gap cover. And I've actually had a personal experience 91 00:04:17,440 --> 00:04:20,480 Speaker 3: of this with my mom. My mother has gap cover. 92 00:04:20,880 --> 00:04:22,640 Speaker 3: I think, especially as you get older, you need to 93 00:04:22,640 --> 00:04:25,159 Speaker 3: make sure you have these things in place. And she 94 00:04:25,279 --> 00:04:27,560 Speaker 3: did not tick that box to say she had gap cover, 95 00:04:28,160 --> 00:04:30,840 Speaker 3: and the specialist submitted the bill to the she had 96 00:04:30,880 --> 00:04:33,560 Speaker 3: an operation. The specialist submitted the bill to the medical scheme. 97 00:04:33,600 --> 00:04:35,800 Speaker 3: The medical scheme had quite a big shortfall. They didn't 98 00:04:35,839 --> 00:04:38,760 Speaker 3: cover a portion of that of that specialist. And I 99 00:04:38,920 --> 00:04:40,960 Speaker 3: was waiting for the invoice and the balance and that 100 00:04:41,040 --> 00:04:42,800 Speaker 3: I could, you know, to pay it and then sort 101 00:04:42,839 --> 00:04:44,720 Speaker 3: out the gap cover. And we never got the bill. 102 00:04:44,800 --> 00:04:49,160 Speaker 3: And then I contacted the surgeon and they said no, no, no, 103 00:04:49,240 --> 00:04:53,719 Speaker 3: there was no shortfall because ultimately, if she had gap cover, 104 00:04:54,360 --> 00:04:55,080 Speaker 3: they would. 105 00:04:54,800 --> 00:04:56,800 Speaker 4: Have sent the bill. So I think we need to 106 00:04:57,320 --> 00:04:58,239 Speaker 4: and I am raised. 107 00:04:58,240 --> 00:04:59,920 Speaker 3: I have been raising this quite a lot in art 108 00:05:00,160 --> 00:05:03,960 Speaker 3: to say to what point is the insurance creating the problem. 109 00:05:04,520 --> 00:05:07,640 Speaker 4: We may have very many and heavy specialists songs on. 110 00:05:07,560 --> 00:05:09,800 Speaker 3: The line scene, but I think we do need to 111 00:05:09,880 --> 00:05:12,640 Speaker 3: wonder to what extent you know that this is sort 112 00:05:12,680 --> 00:05:14,120 Speaker 3: of pushing out prices as well? 113 00:05:14,200 --> 00:05:18,000 Speaker 1: I agree agree now the question as to who should 114 00:05:18,040 --> 00:05:20,000 Speaker 1: should have it. So when I went to go and 115 00:05:20,040 --> 00:05:23,040 Speaker 1: started working with a financial advisor, what's seven eight years ago, 116 00:05:23,720 --> 00:05:26,880 Speaker 1: and she said to me, you need to have gap cover, 117 00:05:27,040 --> 00:05:30,520 Speaker 1: And as I said, you know in the introduction, it's 118 00:05:30,560 --> 00:05:33,280 Speaker 1: not something I'd ever thought about really, And I think 119 00:05:33,320 --> 00:05:35,560 Speaker 1: when I did then think about it. I kind of thought, gosh, 120 00:05:35,600 --> 00:05:37,760 Speaker 1: what isn't that what I'm playing my medical aid for? 121 00:05:38,400 --> 00:05:41,560 Speaker 1: So is it something that everyone on a medical scheme 122 00:05:41,640 --> 00:05:44,280 Speaker 1: should have or does it really depend on the type 123 00:05:44,320 --> 00:05:46,760 Speaker 1: of plan you're on, because this was you know, I've 124 00:05:46,880 --> 00:05:49,200 Speaker 1: since being on a medical aid when I came back 125 00:05:49,200 --> 00:05:52,120 Speaker 1: to South Africa. The medical aid I have now is 126 00:05:52,160 --> 00:05:54,839 Speaker 1: not as comprehensive as the one that I had sort 127 00:05:54,839 --> 00:05:57,520 Speaker 1: of ten fifteen years ago, because there's now two dependents 128 00:05:57,560 --> 00:06:00,880 Speaker 1: on there, and you know, factors that are different. I 129 00:06:00,880 --> 00:06:04,600 Speaker 1: could afford to have a pretty swishy one fifteen years ago, 130 00:06:04,600 --> 00:06:07,120 Speaker 1: and that's not the situation now. You know, I've got 131 00:06:07,120 --> 00:06:08,080 Speaker 1: an all right one. 132 00:06:08,440 --> 00:06:10,160 Speaker 2: But do we all need it? 133 00:06:10,240 --> 00:06:12,240 Speaker 1: Or are there just some medical aid schemes where if 134 00:06:12,240 --> 00:06:15,240 Speaker 1: you're kind of in the upper echelons of that, you're 135 00:06:15,240 --> 00:06:16,039 Speaker 1: going to be sorted. 136 00:06:17,640 --> 00:06:18,720 Speaker 4: I think you. 137 00:06:18,720 --> 00:06:21,480 Speaker 3: Certainly, if you have more comprehensive scheme, you don't need it. 138 00:06:21,520 --> 00:06:23,119 Speaker 3: And what we are seeing is a lot of people 139 00:06:23,160 --> 00:06:25,920 Speaker 3: perhaps using a basic hospital plan and then having gap cover. 140 00:06:26,560 --> 00:06:29,080 Speaker 3: But one of the things that I find is that 141 00:06:29,640 --> 00:06:32,520 Speaker 3: we could get a lot more out of our medical 142 00:06:32,560 --> 00:06:34,920 Speaker 3: schemes than we realize, and we rely a little bit 143 00:06:34,960 --> 00:06:36,279 Speaker 3: there was too much on gap cover. 144 00:06:36,400 --> 00:06:37,800 Speaker 4: So I'll give you an example. 145 00:06:38,480 --> 00:06:42,600 Speaker 3: I had to be hospitalized recently, and because I went 146 00:06:42,680 --> 00:06:47,760 Speaker 3: to the network hospital and I used a network specialist, 147 00:06:48,200 --> 00:06:52,640 Speaker 3: my scheme paid one hundred of that. You know, I 148 00:06:52,800 --> 00:06:54,720 Speaker 3: was an illness and I was hospitalized for it. There 149 00:06:54,760 --> 00:06:58,000 Speaker 3: was absolutely no shortfall at all. So I think we 150 00:06:58,640 --> 00:07:00,800 Speaker 3: need if we are prepared to use the networks, if 151 00:07:00,800 --> 00:07:03,840 Speaker 3: you're prepared to use the specialists that are on that network, 152 00:07:03,960 --> 00:07:08,280 Speaker 3: and I mean the schemes now have pretty comprehensive specialists networks, 153 00:07:08,720 --> 00:07:11,720 Speaker 3: we don't necessarily have this going to have the same 154 00:07:11,760 --> 00:07:15,240 Speaker 3: gaps in cover, so I think, and I've even recently 155 00:07:15,240 --> 00:07:18,160 Speaker 3: did an article about my mother going to emergency room, 156 00:07:18,760 --> 00:07:21,360 Speaker 3: and that's another big one, right, your medical scheme doesn't 157 00:07:21,360 --> 00:07:24,800 Speaker 3: cover emergency room. Yeah, business understanding, and that's often where 158 00:07:24,800 --> 00:07:28,440 Speaker 3: the gap cover cat could step in. But in this case, 159 00:07:28,600 --> 00:07:31,640 Speaker 3: I knew that if the doctor wrote a motivating letter 160 00:07:31,680 --> 00:07:35,120 Speaker 3: and all the rest, and we got her emergency room 161 00:07:35,480 --> 00:07:38,080 Speaker 3: bills paid in full by her medical scheme. So I 162 00:07:38,120 --> 00:07:41,320 Speaker 3: do think we have got a little bit lazy and 163 00:07:41,440 --> 00:07:44,160 Speaker 3: in one sense of not going to find out, you know, 164 00:07:44,360 --> 00:07:47,960 Speaker 3: let's choose the specialist on our scheme and that will 165 00:07:48,000 --> 00:07:49,960 Speaker 3: keep the costs down. So I would say, if you 166 00:07:50,000 --> 00:07:52,160 Speaker 3: don't have gap cover and you don't want to spend 167 00:07:52,160 --> 00:07:54,840 Speaker 3: more money, go make sure that you understand your scheme, 168 00:07:54,960 --> 00:07:57,160 Speaker 3: what it covers, and get as much as you can 169 00:07:57,240 --> 00:07:57,640 Speaker 3: out of it. 170 00:07:58,000 --> 00:08:00,320 Speaker 1: I think that's also such a good point, and been 171 00:08:00,320 --> 00:08:02,240 Speaker 1: guilty of doing this when it comes to sort of 172 00:08:02,280 --> 00:08:04,840 Speaker 1: November and I get the email round saying, oh, this 173 00:08:04,880 --> 00:08:06,760 Speaker 1: is how much things are going to go up next 174 00:08:06,840 --> 00:08:09,000 Speaker 1: year and this do you want to change your medical 175 00:08:09,080 --> 00:08:11,600 Speaker 1: aid plan? And rather than actually reading all of the 176 00:08:11,640 --> 00:08:14,320 Speaker 1: fine print, I immediately go to that column where it 177 00:08:14,360 --> 00:08:16,240 Speaker 1: talks about how much it's going up and what it's 178 00:08:16,240 --> 00:08:16,640 Speaker 1: going to be. 179 00:08:17,000 --> 00:08:18,680 Speaker 2: And my decision is based on that. 180 00:08:19,320 --> 00:08:21,440 Speaker 1: I don't and I agree with that thing in that 181 00:08:21,640 --> 00:08:23,600 Speaker 1: I wonder how many of us are actually making the 182 00:08:23,680 --> 00:08:27,080 Speaker 1: fall the most use of the medical scheme that we've got, 183 00:08:27,120 --> 00:08:30,160 Speaker 1: and I would be guilty of doing exactly that. If 184 00:08:30,200 --> 00:08:32,040 Speaker 1: you're just joining us this morning at seven forty five, 185 00:08:32,040 --> 00:08:34,200 Speaker 1: you're listening to Weekend Breakfast with Me. Sarah Jane at 186 00:08:34,200 --> 00:08:37,440 Speaker 1: Macguala King absolutely thrilled to be speaking this morning to 187 00:08:37,800 --> 00:08:40,199 Speaker 1: financial journalist Maya Fisher, French who I don't think I've 188 00:08:40,200 --> 00:08:40,760 Speaker 1: spoken to. 189 00:08:40,840 --> 00:08:43,280 Speaker 2: For years, certainly before I had children. 190 00:08:43,320 --> 00:08:45,239 Speaker 1: I don't think we were having a very different conversations 191 00:08:45,400 --> 00:08:48,840 Speaker 1: in the sort of twenty seventeen, twenty eighteen, Smaya, we're 192 00:08:48,840 --> 00:08:51,320 Speaker 1: talking about gap cover this morning. 193 00:08:51,480 --> 00:08:53,280 Speaker 2: Have you got it? Do you need it? 194 00:08:53,360 --> 00:08:56,720 Speaker 1: We're sort of doing a gap cover one oh one. 195 00:08:57,080 --> 00:09:01,559 Speaker 1: So I wonder, then, in what situations might upgrading your 196 00:09:01,640 --> 00:09:06,240 Speaker 1: medical scheme option be a better solutionn't my than getting 197 00:09:06,240 --> 00:09:09,240 Speaker 1: gap cover or is does that situation exist or no? 198 00:09:10,880 --> 00:09:11,559 Speaker 4: I suppose it. 199 00:09:11,520 --> 00:09:14,520 Speaker 3: Does a little bit come down to the costs. And 200 00:09:14,600 --> 00:09:16,360 Speaker 3: I didn't have to have a good laugh because I 201 00:09:16,400 --> 00:09:17,880 Speaker 3: think we all do that. We all look at, oh 202 00:09:17,920 --> 00:09:19,839 Speaker 3: what is that plan? Maybe I should be downgrading you 203 00:09:19,880 --> 00:09:22,600 Speaker 3: stead of finding out what I actually get on that plan. 204 00:09:23,320 --> 00:09:26,920 Speaker 3: So I think you need to do the cost analysis partly. 205 00:09:28,400 --> 00:09:30,720 Speaker 3: But you know, when you're looking at a medical a 206 00:09:30,760 --> 00:09:33,840 Speaker 3: medical scheme, it's not just about the hospitalization. There's often 207 00:09:33,880 --> 00:09:36,440 Speaker 3: other benefits that come with it. So, for example, if 208 00:09:36,480 --> 00:09:38,880 Speaker 3: you have a chronic condition, you may it may be 209 00:09:38,880 --> 00:09:41,720 Speaker 3: beneficial for you to upgrade your plan, and that may 210 00:09:41,760 --> 00:09:45,160 Speaker 3: not be covered necessarily by gap covers. Your medications on 211 00:09:45,480 --> 00:09:49,400 Speaker 3: chronic medication, and I really have seen and I am 212 00:09:49,480 --> 00:09:52,880 Speaker 3: quite an advocate for financial advice because I certainly benefited 213 00:09:52,880 --> 00:09:53,160 Speaker 3: from it. 214 00:09:53,240 --> 00:09:54,000 Speaker 4: I think when. 215 00:09:53,920 --> 00:09:56,440 Speaker 3: You're sitting with and you were talking about your financial advisor, 216 00:09:56,559 --> 00:10:00,360 Speaker 3: they have changed my life plan. Yeah, absolutely, and if 217 00:10:00,360 --> 00:10:03,079 Speaker 3: they understand the plan, they can say and I reach 218 00:10:03,120 --> 00:10:06,640 Speaker 3: got great advice when we were selecting our plans as 219 00:10:06,679 --> 00:10:10,200 Speaker 3: to which plan would meet our specific needs. And I 220 00:10:10,200 --> 00:10:12,600 Speaker 3: think that is that is a really good starting point. 221 00:10:12,640 --> 00:10:14,800 Speaker 3: Is does the scheme that the plan that I'm on 222 00:10:14,880 --> 00:10:17,440 Speaker 3: meet my needs? And then if it meets my needs 223 00:10:17,480 --> 00:10:19,920 Speaker 3: to a certain degree, but there's still this gap cover issue, 224 00:10:20,000 --> 00:10:20,280 Speaker 3: then you. 225 00:10:20,640 --> 00:10:21,280 Speaker 4: Could look at it. 226 00:10:21,720 --> 00:10:23,520 Speaker 3: So I think you do need to really start with 227 00:10:23,559 --> 00:10:26,600 Speaker 3: what is it that you need from your medical scheme. 228 00:10:26,600 --> 00:10:28,080 Speaker 4: But I think another thing. 229 00:10:28,000 --> 00:10:32,280 Speaker 3: Sarah Jane, where where gap cover is becoming very important 230 00:10:32,440 --> 00:10:36,520 Speaker 3: is unfortunately, the sadly the increase in cancer. Sure, so 231 00:10:37,160 --> 00:10:40,199 Speaker 3: we are seeing that the medical schemes, you know, they 232 00:10:40,240 --> 00:10:43,640 Speaker 3: have limits as to how much or to what therapies 233 00:10:43,679 --> 00:10:47,439 Speaker 3: and treatments they will cover. And this is we probably 234 00:10:47,480 --> 00:10:51,680 Speaker 3: spent another hour explaining prescribement benefits. Basically, the schemes only 235 00:10:51,760 --> 00:10:54,440 Speaker 3: have to cover what is available in state hospitals under 236 00:10:54,440 --> 00:10:58,440 Speaker 3: prescribement benefits, and we have a lot of new cutting edge, 237 00:10:59,080 --> 00:11:03,400 Speaker 3: you know, treatments for cancer, and that is where often 238 00:11:03,640 --> 00:11:05,240 Speaker 3: the gap cover STIPs comes in. 239 00:11:05,640 --> 00:11:07,000 Speaker 4: So I think that probably is. 240 00:11:07,000 --> 00:11:09,320 Speaker 3: The one area that I would say, no, make sure 241 00:11:09,360 --> 00:11:12,760 Speaker 3: you understand your oncology benefits on your scheme and how 242 00:11:12,800 --> 00:11:14,959 Speaker 3: it works. And that is the one place that if 243 00:11:14,960 --> 00:11:17,360 Speaker 3: you have cancer in the family, for example, you may 244 00:11:17,400 --> 00:11:19,440 Speaker 3: want to make sure you're on a good scheme or 245 00:11:19,600 --> 00:11:20,760 Speaker 3: it certainly have gat cover. 246 00:11:21,120 --> 00:11:22,600 Speaker 1: I just want to go back to the point may 247 00:11:22,720 --> 00:11:26,199 Speaker 1: that you made about a financial advisor. I didn't have 248 00:11:26,240 --> 00:11:30,360 Speaker 1: one for years because I felt like, first of all, 249 00:11:30,360 --> 00:11:32,640 Speaker 1: I felt like I didn't have enough money to justify 250 00:11:32,679 --> 00:11:35,080 Speaker 1: having or earn enough money to justify having on. I 251 00:11:35,120 --> 00:11:37,280 Speaker 1: really thought it was for you know, those in a 252 00:11:37,320 --> 00:11:39,200 Speaker 1: much sort of higher tax bracket than I was. 253 00:11:39,200 --> 00:11:40,360 Speaker 2: I could not have been more wrong. 254 00:11:41,160 --> 00:11:43,880 Speaker 1: And then it was actually through doing the show that 255 00:11:44,320 --> 00:11:46,360 Speaker 1: I spoke to somebody and thought, Okay, this seems like 256 00:11:46,400 --> 00:11:49,240 Speaker 1: a good idea and it has completely changed, you know, 257 00:11:49,280 --> 00:11:53,400 Speaker 1: and in the last ten years brought to properties and 258 00:11:53,640 --> 00:11:55,920 Speaker 1: had my children and all sorts of things in a 259 00:11:55,960 --> 00:11:59,440 Speaker 1: position I wouldn't have been in just with a little 260 00:11:59,480 --> 00:12:02,160 Speaker 1: bit of not knowledge that I didn't have before. And 261 00:12:02,200 --> 00:12:04,440 Speaker 1: one of them was around gap cover. One was the round, 262 00:12:04,679 --> 00:12:07,200 Speaker 1: you know, looking at looking at a medical aid. So 263 00:12:07,760 --> 00:12:09,840 Speaker 1: and people have sort of said to me, but what 264 00:12:09,920 --> 00:12:12,040 Speaker 1: was the real benefit? And like, it's just having that 265 00:12:12,120 --> 00:12:15,240 Speaker 1: person who has that knowledge, who knows the things to 266 00:12:15,280 --> 00:12:18,280 Speaker 1: look out for, and it can be such small things, 267 00:12:18,679 --> 00:12:21,840 Speaker 1: but that over time are going to make an enormous 268 00:12:21,840 --> 00:12:25,559 Speaker 1: difference to you financially. So and I like to kind 269 00:12:25,600 --> 00:12:27,400 Speaker 1: of suggest to people that if you're going to give 270 00:12:27,679 --> 00:12:30,560 Speaker 1: a gift, if you're in the position to give somebody 271 00:12:30,559 --> 00:12:33,160 Speaker 1: a gift, if you can give them the gift of 272 00:12:33,520 --> 00:12:37,520 Speaker 1: moving towards financial freedom or financial wellness, if it's contributing 273 00:12:37,559 --> 00:12:39,880 Speaker 1: to you know, maybe a session with a financial advisor, 274 00:12:39,960 --> 00:12:41,840 Speaker 1: do it. Because it was really one of the best 275 00:12:41,880 --> 00:12:45,400 Speaker 1: things that I ever did. You mentioned prescribe minimum benefits 276 00:12:45,440 --> 00:12:49,319 Speaker 1: and Crichton sent in a message saying, watch the PMBs. 277 00:12:50,080 --> 00:12:52,360 Speaker 1: My wife has been admitted to hospital three times in 278 00:12:52,400 --> 00:12:54,600 Speaker 1: the last ten years and all we PMBs and are 279 00:12:54,600 --> 00:12:57,480 Speaker 1: fully covered. However, in all cases, the medical aid didn't 280 00:12:57,480 --> 00:13:00,280 Speaker 1: automatically see them as PMBs, and it took extra fit 281 00:13:00,280 --> 00:13:01,640 Speaker 1: from us to get. 282 00:13:01,480 --> 00:13:03,240 Speaker 2: Our money back. How does that work? 283 00:13:03,280 --> 00:13:05,760 Speaker 1: Then, MAYA if it's something as a prescribed minimum benefit, 284 00:13:05,800 --> 00:13:08,080 Speaker 1: isn't that right there in black and white in the 285 00:13:08,240 --> 00:13:09,280 Speaker 1: in the medical policy. 286 00:13:10,600 --> 00:13:14,000 Speaker 3: I love that that input because this is something we 287 00:13:14,600 --> 00:13:17,840 Speaker 3: do see a lot of, is that, and it is frustrating, 288 00:13:18,000 --> 00:13:19,760 Speaker 3: is that you do have to often fight with your 289 00:13:19,800 --> 00:13:22,600 Speaker 3: scheme and the schemes are not as quick to pay 290 00:13:22,600 --> 00:13:25,800 Speaker 3: out as they should be, so you do. And that's 291 00:13:25,800 --> 00:13:28,880 Speaker 3: exactly why knowing your rights, knowing what your scheme should 292 00:13:28,960 --> 00:13:32,599 Speaker 3: be covering, is so important. And that that story that 293 00:13:32,640 --> 00:13:34,960 Speaker 3: I was telling about my mother going to the emergency room, 294 00:13:35,400 --> 00:13:38,960 Speaker 3: it was because when it's all about the codes that 295 00:13:39,360 --> 00:13:42,920 Speaker 3: the doctors submit that they're called the ICD ten codes, 296 00:13:43,080 --> 00:13:46,240 Speaker 3: and it has to that code has to fall under 297 00:13:46,240 --> 00:13:48,439 Speaker 3: the PMB, it has to be one of the PMB codes. 298 00:13:48,720 --> 00:13:51,120 Speaker 3: So it's very important that if it is something like that, 299 00:13:51,160 --> 00:13:52,959 Speaker 3: you go and you say to the doctors what codes 300 00:13:53,000 --> 00:13:56,160 Speaker 3: did you submit? And you do often have to get 301 00:13:56,200 --> 00:14:00,840 Speaker 3: sometimes a motivating letter. So it isn't always Yes, in theory, 302 00:14:01,320 --> 00:14:03,720 Speaker 3: you know it should be automatic, but it's all about 303 00:14:03,840 --> 00:14:07,439 Speaker 3: the codes, and you generally do have to go and fight. 304 00:14:07,559 --> 00:14:09,080 Speaker 3: And I think that is a huge bag there that 305 00:14:09,120 --> 00:14:11,760 Speaker 3: I have with the schemes, and I do tell you something, 306 00:14:11,800 --> 00:14:13,640 Speaker 3: Sarah Jane, I'm going to be testing this out on 307 00:14:13,720 --> 00:14:17,160 Speaker 3: my Ai'm going to be putting some medical schemes plans 308 00:14:17,240 --> 00:14:19,120 Speaker 3: through it to see if you can a should tell 309 00:14:19,160 --> 00:14:21,440 Speaker 3: me where you. 310 00:14:21,360 --> 00:14:23,600 Speaker 4: Know where you should should be going back in questioning. 311 00:14:23,600 --> 00:14:25,120 Speaker 3: So I think that's something I'm going to be testing 312 00:14:25,120 --> 00:14:27,080 Speaker 3: because I think this is one of my frustrations with 313 00:14:27,120 --> 00:14:28,000 Speaker 3: the medical schemes. 314 00:14:28,000 --> 00:14:28,520 Speaker 4: Definitely. 315 00:14:28,640 --> 00:14:28,960 Speaker 2: Yeah. 316 00:14:29,200 --> 00:14:30,880 Speaker 1: I want to just take a listen to this voice 317 00:14:30,920 --> 00:14:35,920 Speaker 1: note from Sue, who has mentioned that gap cover wouldn't 318 00:14:35,960 --> 00:14:38,920 Speaker 1: pay for her daughter's surgery. Let's take a listen to 319 00:14:39,000 --> 00:14:40,760 Speaker 1: this voice note from Sue to all about gap cover 320 00:14:40,800 --> 00:14:41,960 Speaker 1: this morning and weekend breakfast. 321 00:14:43,280 --> 00:14:48,080 Speaker 5: Good morning. To add to the aspect of nuances about 322 00:14:48,160 --> 00:14:51,440 Speaker 5: gap cover. As you know, gap cover fulls the gap 323 00:14:51,480 --> 00:14:56,440 Speaker 5: between what medical Aid pays and your bills, and they 324 00:14:56,640 --> 00:15:00,800 Speaker 5: only pay if Medical Aid does pay a part and 325 00:15:00,840 --> 00:15:03,640 Speaker 5: they will pay the other part. But it does not 326 00:15:03,720 --> 00:15:09,600 Speaker 5: always the case. My daughter had a operation for colon cancer. 327 00:15:09,760 --> 00:15:13,320 Speaker 5: It was done in an unusual way, which was very 328 00:15:13,400 --> 00:15:16,640 Speaker 5: much better for her. She didn't get cut open, it 329 00:15:16,720 --> 00:15:20,440 Speaker 5: was done endoscopically, which means through the rectum. And it 330 00:15:20,480 --> 00:15:26,600 Speaker 5: was a huge tumor with which got removed, and the 331 00:15:26,640 --> 00:15:32,120 Speaker 5: eminent gastraentri large Is actually got a sort of endorsement 332 00:15:32,200 --> 00:15:35,160 Speaker 5: from his peers to do it in this unusual way. 333 00:15:35,760 --> 00:15:39,560 Speaker 5: And because it was an unusual aspect to this operation, 334 00:15:40,360 --> 00:15:44,400 Speaker 5: the gap cover actually wouldn't pay that actually wouldn't pay 335 00:15:44,440 --> 00:15:48,480 Speaker 5: the difference because it didn't fit the conventional mold. It 336 00:15:48,640 --> 00:15:52,840 Speaker 5: saved her being cut open. It saved her, you know, 337 00:15:52,960 --> 00:15:57,280 Speaker 5: having all sorts of after effects. It was really well worth, 338 00:15:57,360 --> 00:16:02,360 Speaker 5: of course having to pay a large amount. But you 339 00:16:02,400 --> 00:16:08,240 Speaker 5: cannot rely on gap cover filling the gap in all cases. Bye, 340 00:16:09,320 --> 00:16:09,760 Speaker 5: Thanks sir. 341 00:16:09,840 --> 00:16:12,800 Speaker 1: Appreciate that we're back with my official French she's joining 342 00:16:12,840 --> 00:16:14,840 Speaker 1: us this morning. Anything that you want to add on 343 00:16:14,880 --> 00:16:17,360 Speaker 1: that maya I think, first. 344 00:16:17,200 --> 00:16:20,320 Speaker 3: Of all, it's a very important point that you made, 345 00:16:20,400 --> 00:16:23,840 Speaker 3: which is that it only pays the shortfall. So if 346 00:16:24,200 --> 00:16:27,400 Speaker 3: there's something your scheme does not cover, and I'll use 347 00:16:27,400 --> 00:16:29,560 Speaker 3: a good example, I had somebody telling me this the 348 00:16:29,640 --> 00:16:32,800 Speaker 3: other day. Their scheme didn't cover the prothesis. So this 349 00:16:32,880 --> 00:16:34,640 Speaker 3: is also part of the problem of having just the 350 00:16:34,680 --> 00:16:40,200 Speaker 3: basic hospital plan, and therefore the gap cover didn't pay 351 00:16:40,200 --> 00:16:42,600 Speaker 3: for it. So your scheme it has to be something 352 00:16:42,640 --> 00:16:46,520 Speaker 3: that the plan that you are on covers, but they 353 00:16:46,600 --> 00:16:48,880 Speaker 3: just make up the difference between what it covers and 354 00:16:48,880 --> 00:16:51,880 Speaker 3: what the actual price was. So this is the danger 355 00:16:51,920 --> 00:16:55,280 Speaker 3: of taking, for example, a basic hospital plan because they 356 00:16:55,440 --> 00:16:58,520 Speaker 3: it may cover less and therefore the gap cover won't 357 00:16:58,600 --> 00:17:01,440 Speaker 3: actually fill in be able to fill in. So in 358 00:17:01,480 --> 00:17:04,280 Speaker 3: this particular case, obviously I don't know the case, but 359 00:17:04,400 --> 00:17:06,800 Speaker 3: it could have been that the scheme. 360 00:17:06,600 --> 00:17:08,560 Speaker 4: Did not pay for it at all. 361 00:17:09,320 --> 00:17:13,160 Speaker 3: I remember many many many years ago when my son 362 00:17:13,200 --> 00:17:16,240 Speaker 3: had his tonsils taken out. They used the Harmonica blade 363 00:17:16,280 --> 00:17:18,520 Speaker 3: and it was very new in South Africa, and the 364 00:17:18,560 --> 00:17:20,960 Speaker 3: scheme said, sorry, we we. 365 00:17:21,000 --> 00:17:22,160 Speaker 4: That is not part of our cover. 366 00:17:22,400 --> 00:17:25,520 Speaker 3: Sure that so, yes, they'll pay for perhaps the for 367 00:17:25,560 --> 00:17:27,479 Speaker 3: a portion of the of the surgeon's cost, but they 368 00:17:27,480 --> 00:17:29,919 Speaker 3: will not cover for the cost of using that Harmonica blade. 369 00:17:29,960 --> 00:17:32,920 Speaker 3: So I think though that is very important to understand, 370 00:17:32,960 --> 00:17:37,240 Speaker 3: and when you are speaking to a specialist and they're 371 00:17:37,880 --> 00:17:42,320 Speaker 3: proposing certain new technologies, it is worth finding out is 372 00:17:42,359 --> 00:17:44,800 Speaker 3: my medical scheme going to pay this and if not, 373 00:17:45,000 --> 00:17:46,920 Speaker 3: does my gap cover cover it? So I think that 374 00:17:47,000 --> 00:17:48,560 Speaker 3: was a very important point to raise. 375 00:17:48,880 --> 00:17:51,760 Speaker 1: So there are some key things that people ought to check. 376 00:17:51,800 --> 00:17:54,840 Speaker 1: When you're going through that list of your medical scheme 377 00:17:54,880 --> 00:17:58,080 Speaker 1: and what's covered, that's going to really be the deciding 378 00:17:58,119 --> 00:18:03,280 Speaker 1: factor in working out if gap cover is necessary. Oh, 379 00:18:03,320 --> 00:18:06,000 Speaker 1: somebody asking this is a great question that not again, 380 00:18:06,119 --> 00:18:08,840 Speaker 1: not everybody knows this. What is the difference between medical 381 00:18:08,880 --> 00:18:10,119 Speaker 1: aid and medical insurance? 382 00:18:10,119 --> 00:18:10,480 Speaker 5: Says Go. 383 00:18:12,320 --> 00:18:13,040 Speaker 4: Very important. 384 00:18:13,119 --> 00:18:17,400 Speaker 3: So medical insurance is completely different to either gap cover 385 00:18:17,560 --> 00:18:22,440 Speaker 3: or a medical aid. So medical insurance insures for certain events. 386 00:18:22,640 --> 00:18:26,640 Speaker 3: So you generally people are taking it out for primary healthcare, 387 00:18:26,680 --> 00:18:29,760 Speaker 3: so it will cover certain GP visits, it will cover 388 00:18:30,640 --> 00:18:35,040 Speaker 3: some medications, those sorts of things, and it will cover 389 00:18:35,160 --> 00:18:38,760 Speaker 3: you for an emergency if you're in a car accident, 390 00:18:38,760 --> 00:18:43,560 Speaker 3: for example, stability at a private emergency facility. But it 391 00:18:43,600 --> 00:18:48,040 Speaker 3: doesn't generally cover hospitalization at private hospitals. So it may 392 00:18:48,119 --> 00:18:50,719 Speaker 3: pay out a little bit of cash for example, if 393 00:18:50,720 --> 00:18:54,119 Speaker 3: you're hospitalized, but it's more. Medical insurance is more. Actually 394 00:18:54,119 --> 00:18:56,199 Speaker 3: you're kind of what i'll call your primary benefits, your 395 00:18:56,280 --> 00:18:59,840 Speaker 3: day to day benefits, and it is it's certainly for 396 00:19:00,040 --> 00:19:03,080 Speaker 3: people who who find medical you know, they just can't 397 00:19:03,119 --> 00:19:08,080 Speaker 3: afford medical aids is definitely fitting a space there, but 398 00:19:08,160 --> 00:19:10,639 Speaker 3: people do need to understand that if they want to 399 00:19:10,640 --> 00:19:13,440 Speaker 3: go for an elective surgery or something like that, they 400 00:19:13,480 --> 00:19:16,120 Speaker 3: will be treated in the government hospital. So I think 401 00:19:16,119 --> 00:19:19,879 Speaker 3: it's important to understand what a medical insurance does. And 402 00:19:19,920 --> 00:19:23,840 Speaker 3: the other thing is with medical insurance is that it 403 00:19:23,920 --> 00:19:26,240 Speaker 3: is it's an insurance. They are actually able to risk 404 00:19:26,280 --> 00:19:28,320 Speaker 3: great and they can say, well, we're not going to 405 00:19:28,359 --> 00:19:31,320 Speaker 3: cover you, or we're going to charge high premium for conditions. 406 00:19:31,760 --> 00:19:35,560 Speaker 3: Medical schemes are not allowed to risk great. So if 407 00:19:35,560 --> 00:19:37,879 Speaker 3: you it doesn't matter if you have diabetes or you 408 00:19:37,960 --> 00:19:41,000 Speaker 3: have any of these chronic illnesses, you won't pay more 409 00:19:41,440 --> 00:19:44,400 Speaker 3: than someone else, maybe Sarah Jane to my gap cover. 410 00:19:44,480 --> 00:19:46,720 Speaker 3: But just to go back to medical schemes, but they 411 00:19:46,760 --> 00:19:50,080 Speaker 3: are allowed to charge a premium for people who join. 412 00:19:50,000 --> 00:19:52,760 Speaker 2: Late yes ages thirty thirty five, and. 413 00:19:52,880 --> 00:19:53,960 Speaker 4: That's very important. 414 00:19:54,080 --> 00:19:56,359 Speaker 3: They can charge you a late penalty, join a fee, 415 00:19:56,840 --> 00:20:00,000 Speaker 3: and that will make medical scheme, medical belonging to medical 416 00:20:00,359 --> 00:20:00,879 Speaker 3: far more. 417 00:20:00,760 --> 00:20:01,520 Speaker 4: Expensive for you. 418 00:20:01,640 --> 00:20:04,359 Speaker 1: Yeah, for sure, this has been such an informative and 419 00:20:04,840 --> 00:20:05,840 Speaker 1: helpful conversation. 420 00:20:05,960 --> 00:20:06,200 Speaker 3: Maya. 421 00:20:06,200 --> 00:20:09,320 Speaker 1: I really really appreciate your time on this, Thanks very much. Indeed, 422 00:20:09,359 --> 00:20:12,040 Speaker 1: before we let you go, and you're mentioning articles that 423 00:20:12,040 --> 00:20:14,080 Speaker 1: you put remind us of your your websites. 424 00:20:14,160 --> 00:20:15,720 Speaker 2: People can find themselves there, not just on. 425 00:20:15,880 --> 00:20:18,359 Speaker 1: Gap cover, but on all the range of topics that 426 00:20:18,400 --> 00:20:18,960 Speaker 1: you talk about. 427 00:20:19,040 --> 00:20:21,680 Speaker 2: It's money mentors, is it so money? 428 00:20:22,040 --> 00:20:24,960 Speaker 4: Money? Maya on Money is my website. 429 00:20:25,040 --> 00:20:27,080 Speaker 3: And then I also write for News twenty four and 430 00:20:27,160 --> 00:20:29,320 Speaker 3: in fact it's on News twenty four. I've got a 431 00:20:29,320 --> 00:20:33,320 Speaker 3: Maya Money column there that I recently wrote about emergency 432 00:20:33,400 --> 00:20:35,520 Speaker 3: rooms and how to get your medical aid to cover that. 433 00:20:35,840 --> 00:20:38,640 Speaker 1: Ah okay, yeah, that is a good one. I'll tell 434 00:20:38,680 --> 00:20:41,280 Speaker 1: you what, because actually that the hospital is closest to 435 00:20:41,400 --> 00:20:45,320 Speaker 1: my house if I go there for an emergency room visit, 436 00:20:45,359 --> 00:20:47,080 Speaker 1: as I discovered when my son fell out of his 437 00:20:47,160 --> 00:20:50,680 Speaker 1: pram last year and smashed his face onto the pavement. Yeah, 438 00:20:51,040 --> 00:20:54,960 Speaker 1: winning and the motherhood department there. It was in order 439 00:20:54,960 --> 00:20:57,119 Speaker 1: for us to be admitted that it was going to 440 00:20:57,160 --> 00:21:00,720 Speaker 1: cost an extraordinary amount, and luckily it wasn't dire enough, 441 00:21:00,760 --> 00:21:02,480 Speaker 1: so we sort of hot footed it in the car 442 00:21:02,560 --> 00:21:04,040 Speaker 1: up to Vincent Pilotti because it was a lot. 443 00:21:04,359 --> 00:21:05,119 Speaker 2: It was a lot better. 444 00:21:05,720 --> 00:21:08,800 Speaker 1: But I'm sure actually there is a there would have 445 00:21:08,840 --> 00:21:10,880 Speaker 1: probably been a I probably could have used my gap 446 00:21:10,880 --> 00:21:13,679 Speaker 1: cover on that. Actually, probably if i'd if I'd have 447 00:21:13,720 --> 00:21:15,159 Speaker 1: worked it out in the moment, but I was in 448 00:21:15,200 --> 00:21:19,840 Speaker 1: panic mom mode. But yeah, it's it's definitely these things definitely. 449 00:21:19,560 --> 00:21:21,359 Speaker 3: Need a little thing on We need it on the 450 00:21:21,359 --> 00:21:23,760 Speaker 3: fridge door. Yeah, to do in case the emergency. And 451 00:21:23,760 --> 00:21:25,040 Speaker 3: this is what my gap cover will cover. 452 00:21:25,480 --> 00:21:26,960 Speaker 2: Yeah, exactly, exactly. 453 00:21:27,200 --> 00:21:29,199 Speaker 1: May I enjoy the rest of your weekend and absolute 454 00:21:29,280 --> 00:21:31,280 Speaker 1: treat t ham you with us again, Thank you so much, 455 00:21:32,000 --> 00:21:34,080 Speaker 1: lovely speaking to my official friends. She was one of 456 00:21:34,119 --> 00:21:37,160 Speaker 1: the first financial journalists that I ever spoke to when 457 00:21:37,160 --> 00:21:38,760 Speaker 1: I started on this station. She used to join me 458 00:21:38,840 --> 00:21:41,440 Speaker 1: quite regularly on the late night show all those years ago. 459 00:21:41,840 --> 00:21:43,800 Speaker 2: A wealth of knowledge. What a treat to have her 460 00:21:43,840 --> 00:21:44,159 Speaker 2: back on