What are the top 5 Questions to Ask about Gap Cover?

In South Africa, medical gap cover is available to anyone who belongs to a registered medical aid. Let’s say your medical aid pays 100% of your hospital stay and medicines. But then your specialist charges a rate at 300%. That means you will be in trouble. Yes, unless you have this medical gap cover, you will be liable for the shortfall of 200%. Gap cover covers this shortfall so that you don’t have to. Here are the top 5 questions to ask about gap cover.

  • Is gap cover still relevant with the NHI?
  • Is gap cover, capped at R150 000, still worth it?
  • Which gap cover providers are the best?
  • How do gap cover providers differ?
  • What do you get from gap cover in 2018?


South Africa has always had good gap cover providers. Some of them are Sanlam, Turnberry, Zestlife and others. By 2018 there had been many changes in the South African healthcare industry. And now the Health Minister Aaron Motsoaledi is planning to bring more major changes. So where does gap cover come into the picture?

After all, we’re being told that the new National Health Insurance (NHI) will be compulsory for all South Africans and that it will be affordable. Aaron Motsoaledi is saying that once the NHI is up and running, there won’t really be any reason to keep medical schemes going.

Let’s look at some of the questions people are asking about medical gap cover –

Is gap cover still necessary in South Africa with the NHI? – Questions to Ask about Gap Cover

Questions To Ask about Gap CoverYes, absolutely. The reason for this is that Motsoaledi has said that medical schemes will still continue to exist in the transition to NHI, saying that they would eventually be gone but the process will still take years.

Jill Larkan of Healthcare Consulting at GTC says that medical Gap cover policies will become more important, more so as medical aids are so expensive. As the government starts to impose more restrictions on private healthcare insurance, gap cover is going to be vital.

Is gap cover, limited at R150 000 a concern? – Questions to Ask about Gap Cover

Yes, the National Treasury introduced a gap cover limit of R150 000 per member and per annum. As medical costs continue to rise, some medical experts say this is hopelessly inadequate as many claims in the oncology field, for instance, are well over this amount. If you have cancer treatment and you exhaust that amount and have a relapse, the insurers won’t cover you.

If I want gap cover, who are the top-ranked gap cover providers?

In May 2018, both Sanlam and ABSA are the top-ranked providers of medical gap cover in South Africa, according to a leading wealth- and advisory firm. Gap cover policies are an insurance product and a couple of core benefits offered by gap cover are the co-payment benefit and additional oncology cover.

Gap cover plans were rated according to the level of benefits provided. Sanlam’s Comprehensive Gap Cover was the top performer for those under 60 while ABSA’s Gold Plan was thought to be the best for individuals and families over 60.

How do Gap Cover Providers Differ – Is it worth doing Research?

Yes, gap cover differs among the different policies in terms of the percentage payout, waiting periods and exclusions. Even on the top medical aid plans, you will need gap cover because there will still be gaps between what your scheme pays and what specialists charge.

What do I get from Gap Cover in 2018? – Questions to Ask about Gap Cover

Gap cover is no longer only pays the difference between the fees from doctors and what the medical aid pays. Most of the best gap cover providers offer to add on products. Look for gap cover that takes care of co-payments, and most essentially take note of what your gap cover excludes.

Everyone on a medical aid who has any doubts on gap cover should speak to an accredited financial adviser so they know exactly how to go ahead into 2019 with the best gap cover.


If you are a member of a medical aid, Complete and submit the form on this page to get a Gap cover quote.

All info was correct at time of publishing