COMPLIMED GAP COVER AND PSEMAS

You may be asking yourself, why do I need gap cover? In certain cases, the cost for in-hospital procedures or outpatient treatment may exceed the base medical aid rate by 5-times. Yes, you read right! It is important to protect yourself and your pocket by choosing Complimed Gap, designed to complement your PSEMAS medical insurance.

What is gap cover? Gap cover does exactly what it says—it covers the gap. Even though you have medical aid, it does not cover 100% of every given medical expense scenario. Gap cover can ensure that shortfalls in your medical aid are covered through simple, affordable and comprehensive cover solutions. And this from only N$356 per month (one main member).

What PSEMAS does:

PSEMAS is the medical aid scheme available to public service employees and their dependants. It pays 95% of agreed tariffs, and members pay 5% to the prescribed PSEMAS medical treatment provider. PSEMAS is  administered by Methealth, who administrates the fund’s operations. That is, registration of members, printing cards, auditing doctors and payment of claims. PSEMAS strives to allow members access to health facilities by negotiating with health professionals to contract with them.

Who their customers are:

Public Servants, offices, ministries and agencies, regional councils, GIPF, Old Mutual and Sanlam. Membership of PSEMAS is voluntary.

What is Complimed GAP?

Complimed GAP is an insurance product specifically designed to complement PSEMAS. It covers the difference between what your medical aid fund covers and what the doctors and specialists charge for treatment in Private hospitals, at the Rate Insured. Without Complimed GAP, you are personally liable to pay the shortfall between what the doctor/specialist charges and what PSEMAS covers.

How it works

It is really quite simple. PSEMAS pays a specific amount of a procedure/treatment/etc. and the gap cover just pays the rest. For example, if a procedure cost N$100, PSEMAS will pay N$95, and Complimed Gap Cover will pay the remaining N$5. A simple and small example, but when dealing with operations and accidents, the Complimed Gap Cover coverage can be substantial. Therefore, Complimed GAP ultimately offers peace of mind that your medical costs will be covered.

For details, please refer to the table below. Rate insured means the “savings” you have for that specific category and that the fund will pay up to that amount. At times there are certain restrictions per year. E.g. N$324,000 per person per year for maternity benefits.

Complimentary cover

• Hospicash. This plan also includes Hospicash, which pays out to the policyholder if the principal insured or registered beneficiary is hospitalised for three or more successive days. Each separate hospital admission is classified as a separate event.
• Funeral cover
• Emergency medical evacuation services
• International travel cover

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