Frequently Asked Questions About Gap Cover

More and more South Africans are looking at the benefits of Gap Cover to add to their medical aid protection. But many people still don’t know much about gap cover. Here’s a couple of frequently asked questions about gap cover that should provide some more info.

What is gap cover?


This is one of the most frequently asked questions. In its most basic form, gap cover is a specialised kind of short-term insurance designed to pay the shortfall (gap) between the specified limit that your aid pays and the actual amount charged for treatment.

Is it possible to have both gap cover and medical aid?

YesFrequently asked questions about Gap, in fact, it is not possible to get gap cover without medical aid. Gap cover is an add-on to your medical aid, not a complete medical scheme in itself. Although they are controlled by different bodies (medical aids are subject to the Council for Medical Schemes, while gap cover is regulated by the Short-term Insurance Act), they complement each other to provide defence against extra medical costs. But even so, it is not necessary to purchase your medical aid and your gap cover from the same provider.

How much will I pay for gap cover?

The costs for cap cover vary, as well as being subject to change based on the options you choose. Mostly, you can expect to pay a minimum monthly premium of about R274 for a quality gap cover policy. Do your research, consult a broker, and find the policy that works best for your budget.

As an example, here are Zestlife’s 2021 premiums for each of their two plans:

One of the most frequently asked questions: is gap cover necessary?

At first glance, gap cover may well seem like a needless expense or even a frivolous luxury. Most South Africans are already struggling to pay their day-to-day expenses, tempting them to ignore the option of gap cover. However, since there are no government regulations about what can legally be charged for medical treatment, doctors and medical experts are free to charge what they want. Any medical procedure could easily cost you more than your medical aid is liable to pay, leaving you to find the rest of the money.

To give just one example, let us look at a typical caesarian section. This procedure can easily cost up to R12 000, while Medical Scheme Tariffs specify about R4 000 cover. In a situation like this, you the member will be liable for a payment of some R8 000. When this kind of amount is compared to a small monthly payment, the importance of gap cover becomes clear.

Are there any limits to gap cover?


Sadly, there are certain limits to gap cover policies. Since gap cover is an add-on form of protection against rocketing medical costs for needed treatment, certain procedures and instances will not be covered by most gap cover policies. These include:

  • Cosmetic surgery
  • Harm incurred as a result of dangerous sports
  • Harm incurred as a result of attempted suicide
  • Complications resulting from the use of drugs and restricted substances
  • Injury resulting from military, police or aviation duty
  • Depression, stress-related illness and mental ailments

Will my age affect my chances of getting gap cover?

Once again, this will depend on the service provider. Certain gap cover policies are unavailable to people over the age of 60, while some are open to everyone. Investigate the different options available to see which policy will best suit you and your dependents.

Get a Quote. Just complete the form and send it to us. It costs nothing to get a quote!

All info was correct at time of publishing