Members of medical schemes should never be fooled into thinking they are safe from hospital costs. They are not, and this is why it is so vital to know where to get medical Gap Cover.
The Council for Medical Schemes and the Department of Health controls a pricing system. This system, known as the National Health Reference Price List, suggests payment tariffs and what medical schemes should pay out.
Because hospitals and doctors are not obliged to adhere to that pricing system, their final bills are often five times higher than what medical schemes are prepared to pay.
These shocking shortfalls then have to be paid by the medical aid member and often create financial nightmares for poor families.
All members of medical aid schemes are eligible to apply for Gap Cover
Gap Cover is normally available cheap and pays the difference between medical aid tariffs and costs of hospital treatments.
So where can you get medical Gap Cover?
There are many financial institutions that offer Gap Cover. A leading company is Zestlife:
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Zestlife Premiums for 2025
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Stratum
- Covers the difference between medical aid payments and bills by up to 500%
- Also, in the event of death, stratum pays monthly premium for an agreed-on period
- Co-Payments – covers the cost to the medical aid member when having to pay their medical scheme up front for a portion of hospital procedures
- Oncology Benefits
- Outpatient Benefits
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Complimed
- Includes a number of cover options, including joint replacements
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Ambledown
- Pays up to 500% more medical aid tariffs
- Co-Payments with chosen service providers
Also, there is a host of websites available for research about Gap Cover options. Clients should do careful research on medical aid options before they decide on any one company.
Premiums differ, depending on benefits selected. The more benefits selected, the higher the costs. Hence we urge clients to consult a broker before making a final choice.
Remember that only members of registered medical schemes can obtain Gap Cover
Members of any medical scheme qualify for Gap Cover and can change between medical aid companies as many times as they like.
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