BUSINESS NEWS - Healthcare planning is increasingly moving away from a one-size-fits-all approach, with more flexible gap cover options allowing financial advisers to tailor recommendations to clients’ household structures, medical aid benefits and budgets.

Traditionally, gap cover has been offered through individual or family plans. However, the needs of a single professional, a couple without children and a single parent with dependants can differ significantly, making personalised advice increasingly important.

James White, Sales and Marketing Director at Turnberry, says the growing range of options is changing how advisers assess clients’ healthcare needs.

“With gap cover offerings becoming less generic, advice needs to become more tailored too,” says White. “It’s about considering what the client needs at that point in their life and how those needs may change over time.”

Matching cover to individual needs

A client’s household structure, age, number of dependants and financial circumstances can all influence the type of gap cover best suited to them.

For example, a single person or a couple without children may not need a family plan, while households with several dependants may benefit from a traditional family option.

Age-based pricing and premiums linked to the number of dependants can also help align costs with a client’s circumstances. Turnberry’s Dynamic option, for instance, offers four age bands, with premiums varying according to age and the number of dependants covered.

However, affordability should not be the only consideration. Clients also need to understand the benefits provided, the limits that apply and the medical expense shortfalls they may still have to pay themselves.

“Affordability is important, but it should be balanced against the level of cover being provided,” says White.

Understanding the gaps in medical aid cover

Gap cover is designed to help with certain shortfalls between what medical schemes pay for eligible healthcare services and what healthcare providers charge, subject to the policy’s terms and limits.

The level of exposure a client faces depends partly on their medical aid scheme and option. Co-payments, benefit sub-limits, Designated Service Provider (DSP) requirements and medical scheme reimbursement rates can all affect potential out-of-pocket expenses.

Considering gap cover separately from medical aid could therefore leave clients without a complete understanding of their healthcare costs.

“Gap cover should not be viewed in isolation,” White explains. “When advisers consider a client's medical aid alongside their gap cover, they can better identify potential areas of exposure and help clients make more informed decisions.”

Advisers also need to explain exclusions and benefit limits in practical terms so clients understand what is covered and where financial risks may remain.

Regular reviews are essential

Healthcare needs and household circumstances can change over time. A client may add a partner or dependant, switch medical aid options or experience a change in income that affects affordability.

Where policy terms allow, gap cover can be adjusted during the year to accommodate changing circumstances, rather than waiting for an annual review period.

At the same time, developments in medical treatments, medicines and healthcare technology can influence costs, while changes to medical aid benefits may affect the shortfalls clients face.

Regular reviews of medical aid and gap cover can help ensure that existing arrangements remain appropriate.

“Regular reviews remain an important part of the advice process,” says White. “Changes to medical aids, healthcare costs and a client’s personal circumstances can all affect whether their current cover remains appropriate.”

Personalised advice in a changing healthcare environment

The growing flexibility of gap cover creates opportunities for advisers to recommend solutions that better reflect individual needs. It also places greater responsibility on advisers to explain the differences between available options and help clients weigh up affordability against the level of protection provided.

Rather than treating healthcare cover as a once-off decision, a personalised approach recognises that financial circumstances, family structures and medical needs can evolve.

For consumers, the key consideration is not simply choosing the cheapest premium, but understanding how medical aid and gap cover work together, what benefits apply and which expenses may remain their responsibility.

As healthcare costs and products continue to evolve, informed advice and regular reviews are becoming increasingly important components of long-term healthcare financial planning.

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