From single to family: choosing cover that moves with you

For South Africans seeking access to quality private healthcare, medical aid continues to be a crucial component. However, it is simply no longer enough on its own. The reality is that, even on the most comprehensive plans, members are increasingly subject to co-payments and medical expense shortfalls that can leave them exposed to unexpected financial risk.

Gap cover is critical in bridging the gap between what medical schemes pay and the actual cost of care, but when it comes to premiums, it is crucial to pick the one that best fits your household's makeup, age, and stage of life, as well as your budget. Having the choice of an individual or a single-family premium helps you balance flexibility and cost-effectiveness, regardless of whether you are a single person just starting your career or a growing family balancing complicated healthcare demands.

Why flexibility matters

Many gap cover providers will offer the option of a single premium that covers an entire family, which will include the policyholder (who does not need to be the main member of the medical aid) as well as their spouse and children. For households with several dependants, this model offers exceptional value. Whether you have one child or five, the premium is the same, depending on the limits of the policy, and this offers substantial savings compared to per-person models.

For younger, single individuals or couples without children, however, a personalised structure that allows for an individual rate can be equally valuable. Paying for a family rate when it is not necessary is an expense that can easily be avoided. This kind of tailored approach makes gap cover an accessible and sustainable solution in the long term.

Life changes. So should your gap cover

As people change, so do their healthcare needs as well. Things like getting married, having children, changing jobs, or receiving a serious diagnosis all have an impact on your medical aid and gap cover requirements. Updating your policies is critical to make sure you are not exposed to unexpected medical expense shortfalls. 

Unfortunately, many people only remember to check their cover when they need to claim, and by then, it is too late. For example, if you get married and your spouse falls pregnant, but they were never added to a policy, there will be no cover for maternity-related expenses. If a couple with individual policies has a child, and gap cover is not upgraded to family cover, the child will also not be covered.

This is why it is so important to work with a broker who understands not only the technicalities of gap cover but also your individual personal and financial situation. Brokers can help you understand the various medical aid options, structures, and benefits, and make sure your gap cover effectively complements this to minimise your risk of medical expense shortfalls.

Making the right choice

There are no ‘one-size-fits-all’ solutions when it comes to healthcare cover. Being able to choose between an individual or family premium gives you more choice when it comes to managing your healthcare costs more effectively based on your current needs. However, the medical aid landscape is complicated, and gap cover needs to fit in with the cover you have. Brokers are invaluable in helping you choose the right cover for your life stage, family dynamic, and budget, making sure you get maximum value even when your situation or circumstances happen to change.

* White is the director of sales and marketing at Turnberry Management Risk Solutions

PERSONAL FINANCE