Home > Medical schemes > General info Updated 08 February 2016 10 facts on the self-payment gap Have you exhausted your day-to-day benefits and moved into your self-payment gap? Here's what it means. 3 Related Discovery nabs 51% of scheme members 10 tips on choosing a medical scheme Like us on Facebook » Subscribe to the newsletter » Ask CyberDoc » Quiz How long will you live? » Medical history Bacteria gallery This is the time of year when many medical scheme members have exhausted their day-to-day benefits, and move into the so-called 'self-payment gap'.If for argument's sake you have R3500 in your medical savings day-to-day account and you have used it all, many schemes have instituted what they call a 'self-payment gap'.Most full medical schemes give their members a medical savings account (MSA), which is anything from 15 - 25% of their contributions.It may not exceed 25%, according to medical scheme regulations. Once this is exhausted, you move into the territory of the self-payment gap on some scheme options.This self-payment gap varies in size according to the scheme and the option you have chosen.Up to a pre-determined limit (which is different for every scheme) you will be liable for the payments until you reach what is called a threshold.These are called above-threshold benefits and once you're through the self-payment gap many schemes will resume paying for day-to-day medical expenses up to a certain limit.It must be noted that the threshold is determined by the number of dependants you have registered as the main member. And so is the size of the self-payment gap. The more dependants you have, the bigger the self-payment gap - but it also takes longer to get there, as your contributions would be higher than those of a single member, and therefore your MSA also larger.Do remember that your scheme will still pay for things such as chronic medication, hospitalisation and other benefits not covered from the medical savings account.It is important that you continue to submit claims to your medical scheme even when you are in the self-payment gap, otherwise they will not know when you have gone through it and qualify for above-threshold benefits.Most schemes have introduced this system in the last few years, largely because of a general change in claim patterns experienced across the industry. Susan Erasmus Susan Erasmus is a freelance writer for Health24. NEXT ON HEALTH24X The value of digital technology in addressing quality care 2017-05-17 04:48 More: Medical schemesGeneral info advertisement Read Health24’s Comments Policy Comment on this story 3 comments Comments have been closed for this article. Logout Comment 0 characters remaining Share on Facebook Loading comments... Other news Lifestyle Here’s why your leg cramps while you sleep – and how to treat it Lifestyle This is how Viagra can help you live longer Lifestyle Why women are opting to get their virginity restored through hymenoplasty Parenting Does mom's dagga end up in breast milk? News SEE: This surprising group is at risk of getting Listeriosis Medical A quick guide to sinus-related congestion From our sponsors WIN a R2 000 beauty voucher! Understanding diabetes self-management Fed up with the Phlemings? Let’s chat diabetes and erectile dysfunction Live healthier FYI » When the flu turns deadly Why the flu makes you feel so miserable Could a deadly flu strain hit SA this winter? Following an intense flu season in the US and UK, should we be worried about our own upcoming flu season? Alcohol and acne » Dagga vs alcohol: Which is worse? SEE: Why you are drinking more alcohol than you realise Does alcohol cause acne? Some foods can be a trigger for acne, but what about alcohol? Dermatologist Dr Nerissa Moodley weighs in.