Sanlam Medical Gap Cover Insurance

There is a big difference between your medical bills and what your medical scheme covers for you. Luckily, with Sanlam medical gap cover, you don’t need to worry about that The shortfall will be covered fully and the monthly payment is as low as R250.

The cost of your hospital procedure or outpatient treatment might be five times higher than what your medical aid is willing to pay for. With Sanlam Medical Gap Cover Insurance, there are no extra payments to worry about. You and your family have full protection.

See for more details:

  • How it works
  • FAQ
  • Plan details
  • Buy online

How does Sanlam medical gap cover insurance work?

The graph below illustrates the payment supplied by medical aid and gap cover in these cases:

  • Natural childbirth
  • Leg fracture
  • Sanlam Medical Gap CoverEndometriosis
  • Spinal surgery

Frequently Asked Questions

Why do I need gap cover?

Having gap cover is essential not to end up in a situation where you have to foot the bill for your costly medical procedure because medical aid will only cover part of the actual cost. Sanlam Medical Gap Cover Insurance is a solution to that problem as it guarantees to you and your family members that you won’t be left with a huge excess amount to make on your own.

Do I qualify for gap cover?

  • You have to have a registered medical aid membership
  • Included in gap cover is, of course, the principal member, their partner and children (below the age of 27). Those families that take out 2 medical aids have cover from one Sanlam Gap Cover policy
  • You can include special dependents based on your needs

Are there any waiting periods?

Yes, there are the following periods:

  • 3-months-long waiting period applies on all benefits
  • In case of pre-existing conditions the waiting period extends to 12 months; you will received support or treatment for the duration of the 12 months prior to the cover commencing

Is there cover for all treatments?

  • Those co-payment with a not defined rand amount (applied as a percentage). Please note that this excludes the oncology co-payment cover.
  • Claims made after a period of 6 months
  • There is cover for special dentistry only on the Sanlam Gap Cover Comprehensive Plan in case of trauma, cancers and tumours
  • All cosmetic surgery treatments, with exception for those necessary in the event of trauma or as a result of oncology treatment (e.g. breast reconstruction following a mastectomy)
  • Obesity treatments, including bariatric surgery (stomach stapling)

How much does it cost?

  • It’s affordable. Premiums range from about R300 to R600 per month depending on what plan you choose. One policy covers the whole family.

How do I make a claim?

Xelus Pty (Ltd) assesses claims as the administrator of Sanlam Gap. You need to make a claim within 6 months of your treatment or procedure.

Send claim submissions to:
Email: [email protected]
Fax: 086 501 8521
Or contact Xelus at: 0861 11 11 67

You must submit these documents for claim processing:

  • Receipts from the medical scheme
  • Your current medical scheme membership certificate (Sanlam does not accept copies of the membership card)
  • Hospital account (the first 4 pages that show admission and discharge date and time, as well as times and ICD codes)
  • Relevant doctors’ accounts

The member will receive an e-mail and SMS when:

  • The claim has been received
  • Additional documents are needed (assuming you have not signed the authority form)
  • The claim has been officially authorised

Please keep in mind  –  payments are made directly into the bank account of the principal member of gap cover

If you belong to a medical aid, please complete and submit
the form on this page to get a quick gap cover quote.

All info was correct at time of publishing