The benefits of having Gap Cover & Why it is essential

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The benefits of having Gap Cover: Why it is essential

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The benefits of having Gap Cover: Why it is essential

According to the latest annual council report (CMS), over R32 billion is spent out-of-pocket each year in South Africa. This indicates medical aids schemes are no longer enough to cover all our medical expenses.

You may think you are well covered and have planned for your health expenses with medical aid, but have you considered that your medical plan may only cover up to 200% of medical aid rates? This might not be enough, because the average private specialist charges up to 600%. This is where Gap Cover steps in.


What is Gap Cover?

Gap Cover is an extension of your medical aid since it protects you from certain medical expense shortfalls that your medical aid doesn’t cover.

Gap Cover, depending on the plan, can include additional benefits like sub-limits, standard co-payments and deductibles. Some plans include shortfall cover for cancer treatments, and access to lump sums in the case of accidental death or permanent disability.

Gap Cover is neither a medical aid nor a substitute for it. Instead, it complements your medical aid, meaning you cannot qualify for Gap Cover if you do not belong to registered medical aid.


The benefits of having Gap Cover

Protection against unexpected medical expenses

Gap Cover takes care of your medical expense shortfalls, providing additional cover of up to 500%. For example, if you were involved in a terrible accident, hospitalized and had to undergo surgery, your medical aid would cover that. But if the charges for procedures done run over what your medical aid covers, Gap Cover will cover the difference.

Taking your medical aid plan to the next level

In this economy, medical aid is already expensive and not everyone can afford comprehensive plan types. But did you know that your entry-level medical aid plan type can be complemented with Gap Cover, and you can be covered for up to an additional 500% of medical aid rates without breaking the bank? The icing on the cake is that some insurance providers have premiums that are less than R200 per month.

Access to better quality healthcare

When you are diagnosed with a condition or disease that is treatable but expensive, getting quality healthcare is the primary goal. No matter what medical aid plan you are on, Gap Cover offers security. This enables people to choose the best providers without worrying about whether their medical expenses will be fully covered by their Medical Aid.

For example, cancer can take a toll on the person diagnosed and those around them. It does not help that some oncology related procedures can cost way above your affordability. Some insurance providers will cover 20% of your oncology related procedures, provided your treatment plan is approved by the medical aid. This ensures you are covered and get the best quality healthcare.

Peace of mind

If you ever go through health difficulties, the one thing you need is peace of mind instead of constantly worrying about costs. Knowing that you have additional cover just in case medical expenses go way above what your medical aid covers can alleviate financial stress and allow you to focus on your health.

What does Gap Insurance cover?

In instances where your medical expenses are above what your medical aid covers, Gap Cover will step in to help you cover some of those medical expense shortfalls. Even when your medical aid covers 100% or 200%, expenses can go above that. This is why Gap Cover pays up to an additional 600% for medical expense shortfalls. This is one of the many benefits subject to limits and exclusions.

Here are some examples of Gap Cover benefits:

  • Sub-limits for internal prosthetics
  • Dental reconstruction for accidental injury
  • Oncology co-payments
  • Tariff shortfalls

There are many other benefits covered by Gap Cover depending on the insurance provider and the plan option.

In conclusion, Gap Cover comes with numerous benefits that can protect you against unexpected medical expense shortfalls. It also gives you access to better quality healthcare services and provides peace of mind. Hopefully, this article has shed some light on Gap Cover, its benefits and why it is essential to consider adding it to your existing Medical Aid plan.

Frequently asked questions

What exactly is Gap Cover, and how does it differ from regular medical aid?

Gap Cover is an insurance policy that compliments your medical aid. It covers you for certain medical expense shortfalls. Unlike Medical aid, Gap cover is a non-life insurance product

Can Gap Cover be obtained independently, or is it only for those with existing medical aid plans?

Gap Cover is complementary; it requires you to belong to a medical aid. It cannot be obtained independently.

What types of medical expenses does Gap Cover typically address?

Gap Cover addresses various expenses, including tariff shortfalls, sub-limits for internal prosthetics, dental reconstruction for accidental injury, and oncology co-payments and standard co-payments and deductibles

How does Gap Cover enhance access to better quality healthcare?

Gap Cover provides financial security, allowing individuals to choose top-tier healthcare providers without concerns about full coverage by their medical aid.


Not all Gap Cover plans are the same and benefits as well as limitations may vary. Descriptions of benefits given are meant to be for general educational purposes only and you must ensure that you seek the advice of a broker to ensure any product choice you make suits your individual needs.

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