Perhaps it's just me, but it seems that everyone is out to make as much money out of a situation as possible, irrespective of whether its right or wrong. But, then again, I suppose in these times of little personal consequence, there's no harm in pushing the envelope as far as one can to see whether one can get away with trying their luck.
Recently, a rider involved in an accident became indignant when he couldn't claim from his insurer because his medical aid had already paid the costs of the ambulance and hospital treatment! He was incensed at the cheek of it all, considering that he had 'extra' accident emergency cover. The reality of the insurance environment escaped his scrutiny in a misguided effort to gain from the accident, and perhaps we all need to understand the nature of insurance cover for which we pay.
Firstly, have you read all the policy documents that come with the insurance cover that you have taken out? Probably not, but it's a good thing to take a few minutes to read your policy before mouthing-off about how unfair you feel the system is. In this country (as in most), there are a number of health insurance products on the market. Primary amongst these is the Medical Aid that we all rely on, and while it is not insurance in the true sense of the word, medical schemes serve as primary cover in the event of an accident.
Medical aid schemes come in a variety of options - some only covering in-hospital expenses and treatment and others offering a full service in or out of hospital. In most cases, they will cover everything associated with an accident, including ambulance, emergency room treatment, hospitalisation and post-operative care and treatment. In the case of an accident or medical claim, your medical aid is first-in-line to settle the bills. After all, that's what you are paying for - right? Where a medical scheme offers limited cover, insurance companies offer Gap Cover policies that take-up the slack that can prove very costly.
Then you get the pure medical insurance policies that do much the same as your medical aid - except for seldom paying your day-to-day expenses, and which (depending on their structure) cover the costs of both in and out of hospital accident/emergency/health claims. These are more complicated than we have the space here to explain, but they range from accident cover to selected medical cover in the absence of medical aid. Many polices out there only pay out after a few days in hospital, so check your cover and make allowances for what is and isn't covered.
But whatever cover you have for hospitalisation or emergency care, in the event of an accident - and where you have medical aid, no insurer will - or may pay once your medical scheme has settled the bills. It just doesn't work like that! Medical aid is the big kahuna when it comes to hospitalisation and medical costs, and it is illegal to 'double-dip' by claiming from your insurance company for costs already settled by your scheme.
So, if you have a medical aid and additional extensive medical insurance cover, you need to think about the money that you are wasting in the hope that you will hit the jackpot. Chose one or the other - or even a combination of both, but doubling-up is not going to work. A Gap-Cover policy is always helpful if your scheme has limitations on fees and charges, but remember that it is possible to be over-insured. Ensure that your cover makes allowance for all types of emergencies and that you have disability cover - something which is rarely covered by a medical scheme.
And above all. Read your policy wording when you get it. It could save you a lot of embarrassment and stress in the future.
Guardian Angel offers riders two options when it comes to emergency medical cover. The first is an embedded accident emergency fund of R10K which guarantees that medical and emergency services are dispatched to the scene of your accident without the need for approval from your medical scheme or insurer. This speeds-up the response time you need after an accident and it allows medical staff to stabilise you while authorisation is obtained from your insurer. However, this guarantee falls away once your provider takes-over your case and there is no payout from this option unless they fail to settle the full cost of your emergency treatment (limited to R10K).
The second option is a medical insurance product that provides R100K cover for those that don't have medical cover - or a separate insurance policy. In this case, the emergency dispatch guarantee is the same and through our partners, your entire recovery and treatment is covered to this value from start to end. The Care option offered in conjunction with our partners provides cover for up to five family members for both on- and off-bike emergencies.
Please Note: Guardian Angel is not an insurer or medical aid scheme. The above comments are not to be interpreted as financial or medical advice. We strongly recommend that you contact your broker for financial, insurance and medical scheme guidance to suit your needs and lifestyle.