Medical Aid Coverage Gap Solutions – Get a Quote

The Medical Aid Coverage Gap Explained

Many people still require medical gap cover being explained to them as they don’t understand how it connects to their medical aid. Many believe it is medical aid coverage.

For starters, no-one can buy medical gap cover unless they actually belong to a registered medical scheme. So if you don’t belong to a medical scheme as a member, then you don’t need to have medical gap cover explained to you. You can’t buy gap cover independently.

Gap cover allows you access to good medical care

Gap cover can bring you a sense of peace because it ultimately allows you access to good medical care. It can even cover co-payments – a dreaded, upfront amount. You sometimes have to first pay a co-payment before you can even think of having treatment. No co-pay, no treatment.

The gap cover is available for the corporate market as well as for private individuals and families. It’s a case of signing up for a gap cover plan that appeals to you. Gap Cover is then charged as an affordable monthly premium.

As mentioned, in South Africa, there are many gap cover providers. It will be wise to look at some of them and how they apply to your situation.

Know the differences – entry-level gap may not be good for you

If you have a family, especially with young kids, you may find that the entry-level gap cover products are inadequate. Maybe you need to look at the more comprehensive- or premium products as they will include important benefits such as co-payment cover.

With all gap cover, you’re likely to find they have a complimentary mobile app service. This gives you access to all your gap cover details any time you like.

This much-needed medical gap cover pays for in-hospital treatment amounts your medical aid only partially pays because they believe the medical professional is charging too much.

So if your doctor charges you R50 000 for a particular procedure and your medical scheme believes it should only be R20000 charged, someone has to pay for the R30000 still outstanding. As your medical aid will only pay for the R20000, without gap cover, it is you, the medical aid member who will pay.

This medical top-up insurance is luckily a low-cost, high-value insurance product. It’sfor when your medical aid doesn’t cover all the costs of a procedure you have had in hospital. Having it can save you from unexpected medical bills that you will have to pay out of your pocket. 

Some doctors won’t treat you without gap cover

It’s important to have gap cover, because these days, there are even some specialists who first check if you have gap cover before operating on you.

They want to know that they’re going to get their full payment quota, and without you having gap cover, they know that they will have to wait a long time for you to take out loans to be able to pay off your bill  to them.

Gap cover is optional – but necessary

This all-important gap cover is short-term insurance that protects you against these shortfalls.  You don’t have to have this gap cover – it is totally optional – but how will you pay your co-payments and shortfalls without it?

You can see that it important to know exactly what kind of gap cover your plan entails and to even have your broker explain the gap cover to you.  



Extend your medical aid coverage now by getting gap cover. We will supply you with a quote. Just complete and send the form on this page so we can contact you.