The Essentials of Medical Shortfall Insurance from Essential

Medical Shortfall Insurance from Essential always pays the gap that arises when doctors charge more than the standard aid rates.

The bulk of medical schemes in SA do not fully cater for hospital and doctors fees thus creating added financial burdens for members.

For this reason, Essential’s Gap plan covers you for those sudden and extra costs by up to 400% of the fixed medical rates.

Further, some of the added cost covered include, Surgeons, Anesthetists, and in-hospital procedures

Policyholders from Momentum, Discovery, and Liberty Medical schemes qualify for the Gap cover from Essential. Besides, members from other South African Medical Aid plans can also apply.

medical shortfall insurance from essentialClaims

When submitting a claim, you should supply the following documents:

  • Copies of doctors account for hospital stays
  • Copies of hospital accounts
  • And the essential gap cover claim form

Essential transfers funds straight into the policyholder’s bank account within 14 days of making a claim.


Do you need Medical Shortfall Insurance from Essential?

The answer is yes. Indeed, if your reply to any of the questions below is “yes”, then you should visit the company website.

  • Are you an active member of any health aid?
  • Is that medical cover your only financial protection in the event that you are hospitalised?
  • Are you thinking of lowering your health cover to save on cost?
  • Are you worried about the steady cutbacks in medical aid benefits and thinking of upgrading your insurance for better cover?
  • In the event that you are hospitalised, are you worried about having funds to pay extra costs?
  • Are you sick of co-payments?
  • Do you want peace of mind about meeting extra medical expenses?

Essential knows that people do not want to worry about money when they are in poor health. By getting Gap Cover you will be saving yourself and your family a lot of stress.


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All info was correct at time of publishing