Have an active lifestyle? Mind the gap

By: Turnberry Management Risk Solutions

South Africans are becoming increasingly health conscious, realising the benefits of going to the gym, running, walking, cycling, and other cardiovascular activities.

But despite this growing realisation, too few of us take the risks of exercising seriously, and most kinds of physical activity and sport carry some risk of injury and hospitalisation. Unfortunately, not all specialist bills may be covered in full by one’s Medical Aid – leaving a ‘gap’ which puts us into a financial jam.

Gap Cover has emerged as an effective way to fill this medical expense shortfall. It acts as a complement to one’s Medical Aid: mitigating the risk of those heart-sinking, crippling medical expense shortfalls, while keeping your total monthly insurance premiums at affordable price-points.

For just a couple of hundred rand a month, sports enthusiasts and anyone else at risk of an accident is able to lead an active lifestyle, knowing that the Gap Cover will provide much-needed protection in the case of medical shortfalls (for hospitalisation and specialised treatment).

This was the case with Pierre Rocher. As an experienced cyclist who has completed several mountain bike endurance events, including the Absa Cape Epic races, he ended up benefitting from gap cover when having a nasty cycling accident.

One of Pierre’s favourite weekend pastimes is heading out to a mountain bike trail, to burn off some steam after a long week at work. As he approached a tricky section, he headed into a ‘jump’ without enough momentum, and the bike landed badly. Pierre careered over the front wheel, flying through the air and ploughing into the ground – with his head taking the brunt of the force.

With adrenaline flowing through him, Pierre was able to cycle to a nearby farm and call for help, despite an excruciating, burning sensation in his left arm and shoulder. And though initial x-rays didn’t pick up any problems, the pain continued, so after a few weeks he was sent for an MRI scan.

The MRI and another battery of tests showed severe cracks in his C7 vertebrae and damage to the surrounding nerves – so he was then referred to a neurosurgeon for urgent surgery on his cervical spine.

Crippling expenses

All told, his medical expenses reached over R120 000, considering the costs of the neurosurgeon, anesthetist, MRIs and hospital bills, among other costs. With his Medical Aid implementing co-payments and other restrictions on his cover, the total medical expense shortfall was R54 470 (the amount that Pierre would have had to pay out of his own pocket).

Fortunately, in late-2016, he had decided to take out Turnberry’s Premier Gap Cover option – for himself and his family. With comprehensive Gap Cover in place, he was safely covered for in-hospital medical expense shortfalls.

This meant that out of the total medical expense shortfalls of over R54 000, was fully covered for all in-hospital medical expense shortfalls.

Turnberry CEO Tony Singleton says that Gap Cover has emerged in recent years as a smart way of protecting oneself from the runaway costs of medical inflation, as Medical Aids often fail to cover customers’ claims in full.

“For someone like Mr Rocher, who wants to get back in the saddle as quickly as possible and enjoy an active lifestyle, Gap Cover is absolutely essential,” says Singleton. “By choosing an appropriate Medical Aid and Gap Cover combination, he’s saved himself from a huge financial blow, and ensured that he can access the highest-quality medical care.”

It can happen to anyone

Accidents are certainly a part of life, and a high percentage of the claims processed by the Turnberry team are for accidents and emergencies, from people of all ages and walks-of-life. “This reinforces the view that Gap Cover isn’t only for people who are suffering from medical issues or ill health,” explains Singleton.

“The question we have to ask ourselves is – could we afford it if something like this happened to us?” Singleton adds.

“Without Gap Cover in place, Pierre would either have had to foot the bill in cash, enter into payment agreements with the service providers, or perhaps dig into hard- earned savings.”

Pierre continues and says that the accident was something of a wake-up call that shows just how easily accidents happen: “It makes you realise that you are actually vulnerable and that something like this can happen to you at any point.”

Often for just a couple of hundred rand a month, one can sleep easy, knowing that if any major medical costs are lurking on the horizon, the Gap Cover will provide much-needed protection.

But Singleton says that rather than jumping into new policies, one should use Financial Advisors to manage relationships with your Medical Aid and Gap Cover providers (as well as Investment houses and other financial services firms). In this way, you’ll help to ensure that your array of financial and health products are aligned with your unique needs.