Why Bother to Get Gap Cover?

Why bother to get gap cover at all?

Because you won’t  have to pay for the medical shortfalls out of your savings, in the event that your medical aid fails to cover the bill in full.

Gap cover is a way of guarding your savings and your peace of mind.




Medical Aid Members are Not Fully covered

Why bother to get gap cover? Because medical costs often exceed what aid schemes will pay out. After a stay in the hospital, people end up paying extra costs they thought were covered.

Medical aid has pre-conditions printed in fine print and it can be difficult for the ordinary person on the street to understand, let alone identify if there are any loopholes.

A client just wants a cover that assures them that, if they meet their end of the bargain by paying premiums, they are guaranteed the assistance they need in the case of an emergency.

But it is at this point in time you wish you had an alternative means to pay for the shortfall without digging into your savings. It is at this point that you need to have gap cover.


Why Bother to Get Medical Gap CoverCan I Get Gap Cover?

To qualify for gap cover, you must be a member of a listed medical aid. Schemes such as Discovery and Momentum offer great gap cover.

Further, independent brokers also offer gap cover with the same benefits. There are many options to choose from.

As you take out gap cover ensure you have carried out adequate research on the benefits of each one and that they will cover your needs based on your medical aid plan.

Gap cover pays the shortfall in full, regardless of medical aid provider. Further, you can downgrade your medical aid plan and still keep your gap cover.


The process of applying for gap cover is very simple. Also, there is no age limit for the principal member. However, premiums will vary dependant on the age of principal member and the ages of the beneficiaries. The number of allowable beneficiaries will vary from one insurer to the other. Therefore, you as the client must take out a gap cover insurance that you can afford as costs will differ.

So why bother to get gap cover at all?

Medical aid plans are failing to cover medical bills in full. Mostly because the law does not regulate medical experts’ fees, which quite often fall beyond the threshold of what medical aid can cover. Hence gap cover is vital

Once the medical aid pays their share, you can put in a claim from gap cover.

The medical aid will pay health experts directly based on the plan benefits.

The member will receive the outstanding bill and proceed to make a claim to their gap cover provider.

The insurer will pay the member who in turn pays the medical practitioners.

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All info was correct at time of publishing