Gap Cover is for Medical Aid Members Only
Gap cover is a wonderful insurance for members of South African medical schemes.
The purpose of gap insurance (also called shortfall insurance or top-up cover) is to pay your co-payment costs.
What are co-payments?
If you incur high medical costs – such as an operation or consulting a specialist – sometimes your medical aid won’t pay the entire bill. The rest of the expenses are for you to pay personally. Gap insurance pays out your portion of the bill, which is called the co-payment.
How does gap cover work?
A short-term insurance company offering this innovative, inexpensive product takes the risk of your co-payments in return for a low monthly premium. So if your medical aid lets you down, you claim insurance to pay the medical expenses you would otherwise have to pay.
Why doesn’t my medical aid pay in full?
When you medical aid receives a bill, they don’t just pay it. Instead they look at their own internal tariff list to find out what they are prepared to pay for such-and-such procedure or whatever medication. The price that appears on their list is generally a lot less than the amount that appears on your bill. That’s how you get stuck with a co-payment.
Get a gap cover quote now!
Use the form on this page!
Is gap insurance complicated?
Gap cover is not as complicated as medical aid membership. There are only a couple of options to choose from. There are also add-ons for cancer and heart treatments.
Are there waiting periods involved?
No, with a small number of exceptions including pregnancy. As with most types of insurance, the general rule is to sign up for it long before you are likely to need it.
Is gap cover expensive?
Considering that you can save hundreds of thousands rands potentially, this simple, effective insurance is cheap. You can expect to pay a monthly premium around the equivalent of 10% of your monthly medical aid premium for this supplementary product. So if you pay R5000 a month for your medical aid, then gap cover is likely to cost you around R500 a month.
What are the best gap insurance companies in South Africa?
Several short-term insurance companies are specialists in this market. Indeed, only insurance companies may sell gap policies. The medical schemes are not allowed to do so. Among the leading providers are Zestlife, Turnberry, Sirago, Discovery, Stratum and Admed.
How do I get gap cover?
Make sure that you belong to a registered medical scheme in South Africa. The full list of medical aids in South Africa is here. Please note that a hospital plan or medical insurance such as you get from Clientele, for instance, does not count as medical aid. Then get a quote from a top gap cover provider.
Please complete and submit the form on this page so we can send you a quote.