Gap cover pays the difference between medical fees charged by your medical service provider and the actual amount your medical aid will pay for in-hospital treatment. Premiums for Gap insurance are affordable and very much needed. So what are gap cover premiums?
Most South Africans are shocked when they find out that their medical schemes will not cover all their medical expenses. The 
difference between the amount paid by your medical scheme and the tariff charged by you specialist is called the shortfall. You will be liable to pay that amount out of your wallet.
It is advisable to ask you specialist before treatment what the fees will be. If you have a good knowledge of how your medical scheme operates, gaining information on the cost of planned procedures will be able to see what your Gap payment is going to be.
Gap Cover Providers – What are Gap Cover Premiums
There are a variety of good service providers in South Africa who knows and understand the importance of gap coverage. Here is a list of some established providers.
Gap cover is a product available to active members of a registered medical scheme only. Premiums vary from provider to provider. But it is the member’s responsibility to pay premiums on time. Unsuccessful debit orders will run through in the next month, including premium in arrears and if the provider is having problems with the 2nd attempt, they will cancel the policy.
Premiums For 2025 – What are Gap Cover Premiums
Take Zestlife’s 2025 premiums for example:
No regulations are on the fees that specialists can charge, and both them and doctors charge high above the medical scheme benefits.
Medical providers and hospitals want to know if you have gap cover. Gap cover protects you against unexpected medical expenses. So medical Schemes will not pay your bill in full, and you will have to dig into your pocket in you don’t have Gap Cover. Gap cover will also pay the amount that your medical aid scheme won’t pay. So if the hospitals charge the NHRPL price, your medical aid will reimburse them the full amount.
Gap cover became a necessity. It is not a Medical scheme but is a positive addition to your scheme that will take care of those unpaid fees.
Gap cover is cheap, get it! You will save money and free yourself of financial stress when medical emergencies arise. The monthly premium is also affordable. So speak to your medical scheme service provider if you need more information on premiums and gap coverage.
Complete the form on this page to get your gap cover quote.
