Facts about Gap Cover Plans in South Africa

South Africans have become steadily disconcerted with their Medical Aid Schemes, simply because there seems to be continuously reduced cover and a growing list of exceptions and exclusions! What you need is good gap cover plans in South Africa, to help supplement your medical aid.

How do gap cover plans in South Africa work?

A survey taken by SACSI (South African Customer Satisfaction Index), in June 2016, indicates that failed claims and exclusions were at the centre of most customer complaints. It is for these reasons that Gap Cover has become necessary.

Gap cover plans in South AfricaGap Cover is a short-term Insurance policy taken out to cover the difference between what your Medical Aid Scheme will pay out and what specialist practitioners, or private medical facilities, are billing you.

Why has Gap Cover become necessary?

There is no legislation restricting what Specialist Practitioners and Private health care facilities can charge in South Africa. Tariffs levied by these entities, are often up to five times higher than standard medical aid rates, leaving member exposed to massive shortfalls. The Insurance industry developed Gap Cover so that Medical Aid members could cover this risk, at an affordable cost.

How do I get in touch with Gap Cover Companies?

There are some excellent gap cover plans in South Africa from Gap Cover Service Providers. Each offering unique policies tailored to cater for needs of the market. Our favourite is Zestlife.

Zestlife Gap Cover

They have two schemes available, offering a comprehensive cover on the one hand and a more affordable option on the other. Premiums in 2019 are as follows:

Zestlife Universal Gap Cover enhanced benefits for 2019 include:

  • Overall regulatory maximum for medical expense shortfall cover increased from R150 000 to R160 000.
  • Cancer lump sum increased from R25 000 to R30 000.
  • Casualty benefit increased from R10 000 to R20 000. Casualty visit must be within 48 hours of the accident.
  • Medical Aid and Gap Cover Premium Waiver maximum increased from R6 500 to R7 300.
  • Medical Aid and Gap Cover Premium Waiver limited to accidental only, but the payment period increased from 3 to 12 months. This change was due to legal requirements.
  • Accidental dentistry maximum increased from R15 750 to R19 250 and amount per tooth increased from R2 250 to R2 750.
  • Non-Designated Service Provider co-payment increased from R8 600 to R9 300.
  • Oncology co-payment maximum increased from 20% to 25%.
  • Cover for robotic procedures up to R30 000.
  • Cover for procedures in day clinics.
  • New Oncology Benefit to cover 20% of treatment cost when oncology limit is exceeded.
  • Varicose veins have been added as an out-of-hospital procedure that is covered.


When contemplating the fact that shortfall costs for childbirth are around R19 000.00 and R109 000.00 in heart bypass surgery, it becomes quite evident that insuring this risk with Gap Cover is now an absolute necessity.

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All info was correct at time of publishing