Medical Gap Cover is Necessary for All Medical Aid Members

Medical gap cover is necessary for everyone who does not want to get stuck paying huge shortfall bills.

Despite having to pay hefty monthly premiums for medical aid cover, users are left high and dry when it comes to hospital procedures.

Naively, many people believe that their aid will cover 100% of their health costs. After all, that is what their medical aid schemes state.

However, they are in for a rude awakening when their hospital bills arrive in the post.

While medical schemes pay 100% of the amounts stated in their contracts for various hospital procedures, they do not cover 100% of the final bills imposed by the medical expert.

Doctors can charge up to five times more than the ceiling rates imposed by medical schemes.

That financial shortfall is then the burden of the aid member who more often than not cannot pay the bills without getting extra funding and landing themselves in more debt.

That is why medical gap cover is necessary.

medical gap cover is necessaryExample One:

Account from anaesthetist: R3,770.90

Payment by medical scheme: R1,482.65

Consumer shortfall: R2,288.25


Example Two:

Account from gynaecologist: R8,833.20   

Payment by medical scheme: R2,759.09

Consumer shortfall: R6,074.11


Example Three:

Account for hospital operation: R12,604

Payment by medical scheme: R4,241.74

Consumer shortfall: R8,362.36


What is Gap Cover?

  • Gap Cover is a form of short-term insurance
  • Applicants must be members of a registered South African medical scheme
  • This insurance covers the principal, his spouse or life partner and children, provided they are all members of the same medical scheme
  • Gap Cover can be obtained for around R274 a month for everyone in the family on the medical aid
  • Benefits are subject to the type of Gap Cover chosen – the more comprehensive and expensive plans cover a host of medical related items
  • Waiting periods range from three months, up to one year for pre-existing medical conditions and pregnancies


Most Gap Cover policies contain exclusion clauses which can include:

  • Suicide
  • Cosmetic surgery
  • Drug addiction and alcohol abuse
  • Motor racing sports
  • Mental disorders
  • Regular doctors’ consultations


Medical Gap Cover is Necessary because

  • It pays the difference between medical aid rates and charges imposed by the medical profession. These can be up to five times more than what a medical scheme will pay
  • Also, it covers Co-payments including scans and hospital admission fees
  • As well as Sub-limits imposed by medical aids
  • Additional cover for certain cancer treatments such as medication, chemotherapy and radiation


Gap Cover may be viewed as a necessary evil, but South Africans have come to realise that without it they could face financial nightmares in times of illness.

Indeed, they are buying peace of mind at an affordable price.

We urge consumers to investigate the myriad of Gap Cover policies available on the market before selecting a product to best suit their needs.

Also, they should consult a broker for further information and assistance.

Apply for a Quote by completing and sending us the form. It’s free of charge to get a quote…


All info was correct at time of publishing