Gap Cover: Frequently Asked Questions

Gap Cover provides short-term insurance products that help you cover certain cost shortfalls between what your medical provider charges and what your medical aid pays.

Fill in your details on this page indicating that you would like Gap Cover. A broker will call you back, run you through a quote and talk you through the 2 Gap options. Policies are bought over the phone, and your policy documents will be mailed to you.

Your spouse and children (up to age 26) may be added as dependants onto your policy.

A minimum of 31 days’ notice is required in order to cancel your policy.

The waiting periods for Dis-Chem Health Gap Cover are as follows:

• 3-month general waiting period, excludes claims as a result of an accident.
• 12 Month Condition Specific waiting period – Applies to any pre-existing conditions.
• If you are transferring your Gap cover from another provider, your waiting periods will be reviewed and possibly waived. Proof of previous cover is required.

They occur when your surgeon or anaesthetist charges more than what your medical aid pays for a procedure or specific code. This is called a ‘tariff’ shortfall.

A lot of them do and the charges vary from 1.5 times above what the medical scheme covers up to as much as 5 times more than the medical aid tariff.

Tariff shortfalls vary according to the fees charged by your medical specialist and also the severity of the procedure. Typically, the shortfalls on minor procedures are several thousand rands and can be anywhere between twenty and forty thousand rands on large procedures.

Yes, they can also occur if your medical scheme imposes co-payments or deductibles on certain procedures, e.g. MRI/CT scans or diagnostic scopes while in hospital.

It all depends on your medical plan and on the type of procedure, but they range from around R2,000 up to as much as R15 000 per case.

The policy does contain some exclusions, please refer to your policy document for the detailed list.

These are optional benefits that you can include in your Gap Cover plan for an additional R75. Lifestyle Benefits unlock extra by Dis-Chem: A 20% discount on over 2,500 products, when you shop at Dis-Chem.

 

Other benefits focus on improving mental wellness such as family counselling, children and teenager support as well as financial and legal advice.

 

For more information on Lifestyle Benefits, click here.

Dis-Chem Health Gap Cover processes claims daily and payable benefit payments to members also made daily. Claims take 7 – 14 working days to finalise once all required documents are received by Dis-Chem Health.

You can visit the website https://dischemhealth.co.za/self-support/ and either download a claim form or complete the online claim form.

Minimum documents required are: fully completed claim form, copy of the Doctors invoice, copy of the hospital account and a copy of your medical scheme statement showing the shortfall.