What You Need to Know About Medical Gap Cover Also Called Medical Shortfall Cover

A question many people ask when it comes to deciding whether or not to get medical shortfall cover is – why should I get gap cover? My medical aid says it will cover all my stay-in-hospital expenses 100%? But this is not the case at all.

Today’s medical practitioners and some hospitals are charging, sometimes, way in excess of the medical aid tariff rates. This creates a shortfall. The person responsible for paying in the shortfall will not be your medical aid – it will be you.

Experts can charge up to 5x more than what your medical aid will pay, and you will need to pay the shortfall.

This medical shortfall cover is known as gap cover. There are many gap cover insurance companies in South Africa that will be able to help you when you’re faced with unexpected bills incurred while in the hospital.

What Medical Shortfall Cover Entails


So whaMedical shortfall covert is gap cover? Gap cover falls under the Short-term Insurance Act. It was designed to help people who belong to medical aids in South Africa. Its to pay for those treatments that medical aid won’t cover.

Many people assume that they were covered 100% by their medical aid, but this is a misconception. You might belong to one of the top medical aids in South Africa, but there will always be specialists and other medical service providers who, because they are unregulated, charge whatever rates they want for your hospital procedures and stay. This can be  300%, 400%, even 500% over the medical scheme tariff guide.

There are always going to be differences between what your medical practitioners are charging and what your medical aid scheme will pay. You have to pay the difference. Sometimes these shortfall amounts can run into thousands of Rands. It is exactly for this reason that gap cover insurance in South Africa was born.


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As long as you belong to a registered medical aid, you can apply for gap cover. On most website pages of the providers, there will be a form to fill in. A  gap cover expert will then get in contact with you to tailor your gap cover need.

Gap cover comes with waiting periods and exclusions. There are some gap cover providers who will only cover your in-hospital treatment. Then again there are others that also include some out-of-hospital procedures.

It is important to read your quote carefully. Gap Cover pays out into your bank account. Then it’s up to you to pay your medical practitioners.

You can be thankful that gap cover exists in South Africa as there have been efforts to scrap it. Imagine paying those enormous medical bills that your medical aid won’t pay. Be eternally thankful for medical shortfall cover – it can save you a lot of financial stress.

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All info was correct at time of publishing