How Gap Cover Insurance Works

Gap cover isn’t new to the medical aid scene but in recent months, the short-term insurance product has moved strongly into the spotlight.

The pandemic has turned everything upside down and with health and medical assistance uppermost in people’s minds, gap cover is receiving new interest.

Many people are looking to downgrade their medical aid plans to make ends meet. Others, aware of how frail their health is, take on even more comprehensive plans as well as gap cover to ensure they’re fully protected from high medical bills.


Gap cover – filling in for medical aid’s shortcomings

Gap cover has come about so as to cover the gap that exists between medical aid rates and what medical specialists charge.
South Africa has many excellent gap cover providers – Admed, Complimed, ABSA, Old Mutual, Sirago, Stratum, Zestlife, Ambledown, Turnberry and many others.

With their reasonably priced plans, you can spare yourself a lot of financial stress. Some have plans that start in the region of R400 while other more comprehensive policies can be over R1000 – it all depends.

Between them all, their core offerings basically cover –

  • Tariff Shortfalls
  • Out of hospital tariffs
  • Accidental casualty
  • Co-Payments
  • Deductibles
  • Shortfalls from Sub-Limits
  • Oncology tariff shortfalls, sub-limits and co-payments

Don’t go without the treatment you need

Also, co-payments that must first be paid by the medical aid member for some treatments, are also covered by gap cover. This is a relief as without co-payment cover, some members have had to give up receiving the treatment they badly need because they simply cannot pay for it.

The constant search for quicker, shorter, stronger and more effective treatments push medical treatment expenses up. Whether it’s new, complex machines or new vaccines, the costs of being treated for illness are becoming so high as to be out of reach.

It is safe to say that without a medical aid plan, you will have to wait for treatment in a state hospital, and by then it may be too late. In South Africa, when it comes to healthcare, you need medical aid cover and you need gap cover. Having gap cover to enhance your medical aid plan means that in-hospital shortfalls are taken care of.



Gap cover – a value-for-money product

If you are a medical aid member, your premium will in all likelihood be between 2- and R6 000 a month, depending on whether you are an individual or family. With some gap cover being in the region of R400 a month, you can see that gap cover is a true value-for-money product that isn’t a nice thing to add on, but a critical necessity.

There was a time when gap cover would only cover in-hospital treatments, but these days many of them cover shortfalls on out-of-hospital treatments too such as CT- or MRI scans.

Specialists charge just what they want – often more than 500% higher than the amount the medical scheme will pay. Not even being on a comprehensive medical aid scheme can keep you from coming across shortfalls like this.

If you don’t want to be liable for the shortfall that exists, you dare not be without gap cover.


Use the form on this page to contact us for a quote. Act now!