How To Buy Gap Cover in South Africa

In this article, we will have a look at how to buy gap cover in South Africa.

  • Gap Cover is a stand-alone insurance policy
  • Only buy a policy from an authorised service provider
  • Assess your individual needs when selecting the cover
  • Remember, the cheaper the policy, the smaller the benefits


How to buy gap cover in South Africa?

In South Africa, Gap Cover is offered as a separate stand-alone insurance policy to members of existing medical aid schemes.

It was designed to fill the shortfall, or gap, between your medical aid pay-outs and those imposed by medical practitioners for in-hospital treatments and procedures. These gaps can be as much as 500% and, if uninsured, opens the door to a financial nightmare.

An element of caution

How To Buy Gap Cover in South AfricaBut there is an element of caution because short-term insurance providers have been forced to reduce the value of many gap cover benefits as private healthcare costs spiral out of control. Remember, insurance companies, unlike medical aids, operate for profit.

Recently a gap cover insurance provider pointed out that over the last three years it is South African insurers and not medical aid schemes that are shouldering the biggest chunk of medical payments. In fact, insurance companies paid up to 80% of medical costs in some cases, leading to a huge increase in medical practitioner shortfall claims.

Nevertheless gap cover is vital – How To Buy Gap Cover in South Africa

Despite this, gap cover is vital if you want to protect yourself and family from forfeiting needed surgeries or treatments and, on the bright side, this form of insurance is still affordable. Gap over is particularly attractive to larger families because all dependents can be listed on the policy, provided they are all covered by your medical aid scheme.

So changing times have heralded changing gap cover products – some insurers will pay up 200% more than your medical aid scheme payment tariffs, while others offer up to five times more – depending on the policy of your choice and related monthly premium payments.

What most gap policies will not cover

  • Ward costs either in hospitals or step-down facilities
  • Private room upgrades
  • Pre-admission consultancy fees
  • Medication
  • External prosthesis (such as artificial limbs)
  • Wheelchairs and crutches
  • Ultrasounds and routine medical examinations
  • Private nursing
  • Mental illnesses
  • Transport costs (ambulances)
  • Dental treatments as an outpatient
  • Cosmetic procedures
  • Using a non-designated service provider (outside of your medical scheme’s network)
  • Co-payments associated with procedures for which you are on a waiting list


Pleasant Surprises – How To Buy Gap Cover in South Africa

But, depending on the type of cover gap selected, there are some pleasant surprises of what your insurance provider will cover. These can include:

  • Out-of-hospital procedures undertaken in a doctor’s surgery
  • Full co-payments for certain specified hospital procedures
  • The shortfall on internal prostheses (such as hip replacements) subject to a stipulated maximum
  • A lump sum payment for first-time cancer diagnosis (terms and conditions apply
  • Lump sum benefits for accidental death or permanent total disability
  • Lump sum payments for long-term hospitalisation
  • Dental repairs (accidental injury)
  • Contributions towards casualty costs (terms and conditions apply)


Add your details to the form on this page to get a Gap Cover quote (if you’re a medical aid member)

All info was correct at time of publishing