How Medical Gap Cover Works

Gap Cover has become a vital short-term insurance policy that covers additional costs. Fortunately, the information below will help you to know how medical Gap Cover works.

Having stand-alone medical aid is simply not enough to cover the cost of treatments.

That is because medical practitioners do not have to abide by the proposed tariffs of medical schemes.

In fact, it is common for the medical profession to charge up to five times more than medical aids will pay.

As a result, medical aid members must pay those extra costs.

These extra costs can amount to thousands of Rands.

How Medical Gap Cover WorksHow Medical Gap Cover Works.

Who Qualifies?

  • All members of a listed medical aid scheme qualify for Gap Cover. They must not be older than 70 at the time of taking out the short-term insurance policy.
  • Gap Cover applies to the principal members and family members. And they must all be registered members of the same medical aid scheme.
  • There are no medical examinations necessary to obtain Gap Cover. As a short-term insurance policy, it is not regulated by the Council for Medical Schemes.

What Gap Cover Excludes

Every Gap Cover short-term insurance comes with its own list of exclusions. These depend on the level of cover taken and the chosen company or scheme

Gap Insurance does not cover the following;

  • Nuclear cover, as well as materials, weapons and fallout
  • Cover for cosmetic surgery or obesity treatments
  • Cover for routine checkups, X-rays or medical tests
  • Mental disorder cover
  • Suicide cover
  • Drug addiction cover or medication unless prescribed by a medical doctor
  • Alcohol abuse cover
  • Cover for members of the military, police, police reservists or active civil or labour unrest, riots, strikes, and the actions of locked out workers
  • Air travel cover unless the policyholder is a passenger
  • Cover for any form of speed or race test
  • Costs involved with private nursing 

It is important to remember that Gap Cover is not a stand-alone medical aid policy.


It is a short-term insurance policy that is used in conjunction with any medical scheme.

Clients are advised to seek professional guidance from an insurance broker, before changing their medical aid policy, or opting to increase monthly premiums for better benefits,

It is also of the utmost important to read all fine print in policy before putting pen to paper.


Get your gap cover quote now. Complete the form on this page and click on the “Get a Quote” button.Find out more about how medical Gap Cover works.


All info was correct at time of publishing