Experts advise on gap cover selection tips

What do experts say about gap cover?

  • Become aware of additional benefits open to you by finding a knowledgable advisor to guide you
  • Try and match your medical aid to your gap cover, in terms of benefits. Read and understand the waiting periods fine print
  • Understand fully your medical aid plan/option, concentrating on where gaps appear and choose a gap cover that addresses those gaps
  • Go for a gap cover that offers a co-payment benefit, and one that is paying 500% times the rate of medical aid
  • Shop around for best deals on different benefits on the various plans


What do people in general say about medical schemes?

Casual chats with a great number of people will reveal complaints concerning hospital stays that leave them financially drained. That is due to medical aid schemes declining claims or expensive co-payments.

While medical aids are only willing to pay one or two times the medical scheme rates, specialists and Experts on Gap Cover for Medical Aid in South Africadoctors are routinely charging up to five to seven times the medical scheme rate!

South Africa does not regulate the fees specialists can charge patients. And as such, medical schemes have resorted to capping the amounts they are willing to pay for. At this point, various financial experts suggest buying gap cover.

Many are asking, is it worth it? Industry experts are increasingly saying, it is.

Gap insurance is a product of insurance that is short term. It mainly covers shortfalls for in-hospital expenses due to differences in medical aid scheme tariffs and specialist, doctors or hospital charges.

Gap cover also funds certain particular benefits for some out-of-hospital. These include counselling, casualty/trauma room cover, oncology, CT or MRI scans co-payments, renal dialysis, radiotherapy or chemotherapy.

Available only to members of a medical aid, gap cover aligns cover with the benefits of a medical scheme. Gap cover products range in premiums from R100 to R1 000, dependant on a host of factors.

According to experts, these are the advantages to gap cover

  • There are define waiting periods, with most providers offering 3 months generally and one year for certain conditions that are pre-existing.
  • People of all ages can acquire gap cover, which was not always the case. There used to be a 60 years and below maximum, but that was eliminated through new regulations affecting insurance products.
  • Gap covers are more or less flexible. Should you switch medical aids, you will only need to notify your gap cover provider, who will also switch your benefits to the new medical aid scheme without new or additional waiting periods.
  • Employers enjoy relief through their employees receive prompt medical care, meaning their employees miss less workdays, boosting productivity.


Who should have gap cover?

Consensus points to anyone with medical aid. Especially useful for those with children, because casualty ward treatment cover is not very common with many medical aid schemes, which is where many younger children are treated.


The need for gap cover will endure as long as there is a shortfall experienced between hospital charges and medical aid tariff limits. It will remain an important insurance product against crippling medical expenses, as long as medical aids do not fully cover in-hospital procedure bills.

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All info was correct at time of publishing