This option assists with covering the medical expense shortfalls between what your Medical Scheme covers versus the private in-hospital rates, especially for the costs of Specialists and Anaesthetists.
A Medical Expense Shortfall is the difference between what medical service providers (e.g. Doctors, basic and specialised Radiology, Pathology, Specialists) charge and what Medical Schemes pay for the treatment performed in hospitals and day clinics, provided that it is paid from the Hospital Benefit of your Medical Scheme.
Medical Expense Shortfall Cover will boost your Medical Aid rate, helping you with this shortfall!
Below is an example of a claim for a Hip replacement
|MEDICAL SERVICE PROVIDER||AMOUNT CHARGED BY THE MEDICAL SERVICE PROVIDER||AMOUNT PAID BY MEDICAL SCHEME||AMOUNT PAID BY TURNBERRY|
|Surgeon||R17 053||R6 021||R11 032|
|Anaesthetist||R8 256||R2 402||R5 854|
|Total paid by Turnberry||R16 886|
Medical expense shortfall expense
Casualty benefit (accidents only)
Medical scheme contribution waiver
Gap premium waiver
International travel cover
|Treatment date of the claims is within:||Benefits for childbirth will be capped at :|
|First 12 months of the Policy||R8 000 per event|
|13-24 months of the Policy||R12 000 per event|
|25+ months of the Policy||Subject to the Overall Annual Limit of the Policy|