Gap Cover
In-Hospital Care
Covers shortfalls for consultations and treatments within a hospital.
Hospital Admission
Co-payments for hospital admissions covered with prior authorisation.
Procedure Co-Payments
Includes co-payment cover for endoscopic investigations.
What is gap cover ?
Gap cover pays for medical expense shortfalls when your medical aid will not cover the full bill. The fact is that your medical aid is not liable for the entire bill that your doctor charges. Schemes pay according to specified tariffs. If your doctor charges above these tariffs, then the medical aid will cover 100% of the tariff while you are liable for the shortfall. This is where gap cover can help.
It is a top up cover that ensures you are financially protected against unexpected medical expenses. Gap cover pays up to 500% of the medical aid tariff and higher plans will also cover co-payments. This is a separate short-term insurance policy from your medical aid and is only available to members of a registered medical scheme.
Your doctors fees may be higher than your medical aid’s rates
Gap cover pays for medical expense shortfalls when your medical aid will not cover the full bill. The fact is that your medical aid is not liable for the entire bill that your doctor charges. Schemes pay according to specified tariffs. If your doctor charges above these tariffs, then the medical aid will cover 100% of the tariff while you are liable for the shortfall. This is where gap cover can help.
It is a top up cover that ensures you are financially protected against unexpected medical expenses. Gap cover pays up to 500% of the medical aid tariff and higher plans will also cover co-payments. This is a separate short-term insurance policy from your medical aid and is only available to members of a registered medical scheme.
Frequently Asked Questions
Is gap cover available to anyone ?
Gap cover is only available to medical aid members of any registered medical scheme in South Africa. Health or medical insurance members do not qualify for gap cover.
How much does gap cover cost ?
The cost of gap cover varies among providers and also depends on plan benefits. Lower cost options may start from R200 per month while premium plans can be in excess of R500 per month.
Does gap cover extend to all hospital procedures ?
Gap cover will only pay for shortfalls of medical aid covered procedures. Medical schemes do not cover non-essential procedures like cosmetic surgery. Therefore gap cover will not extend to these types of procedures.
Are maternity expenses covered ?
Maternity benefits are included in all gap cover plans since medical aid does cover pregnancy and childbirth costs. However, out of hospital maternity care may not fall within the coverage of gap insurance.