Why is Gap Cover so Vital?

Those people who supply medical gap cover to medical aid members might have been a bit concerned with the stricter regulations for gap cover. These medical gap cover providers may have had reason to think that the new regulations would actually discourage people from taking out this medical insurance. So why is gap cover so vital?

  • Gap cover doesn’t only cater to dread diseases but for common ailments too.
  • For an affordable price of R200 a month your entire family benefits from one gap cover plan.
  • Gap cover caters for co-payment and sub-limits.
  • You don’t have to look for huge sums of money to cover hospital expenses medical aid won’t pay
  • There is some gap cover offering additional benefits for cancer procedures, even when some treatments are without needing to go to the hospital.


There is Now a Limit on Gap Cover Payouts – Why is Gap Cover so Vital

The new demarcation regulations cap the payout made to individual medical aid members, and its capped at R150 000 for each year. Before this regulation came in there wasn’t a limit to the amount of gap cover providers could pay.

Gap cover is still as vitally important today as ever. It pays for the shortfall between what your specialist charges you and what the medical aid will pay.

Many people simply believe that being a member of a medical scheme covers you fully for all treatments in the hospital, little realising that this is often not the case. When you start receiving your medical bills, you’ll discover that the bill charged by the specialist exceeds the medical scheme rate by as much as 5x.

With gap cover, however, you can be sure that should you need to undergo a medical procedure which includes a co-payment, your gap cover will take care of the bill. Medical aid without gap cover may mean massive medical bills. The bottom line is that in spite of the new regulations, gap cover is still vitally important to you as a medical aid member.

Why Is Gap Cover So Vital

100% Cover Doesn’t Quite Mean That – Why is Gap Cover so Vital

Medical schemes aren’t all the same. Different premiums bring in different benefits. When doing research for a suitable medical plan that suits your budget, you’ll see you’ll find information saying the medical aid will pay 100%, 200% or 300% of the scheme rate.

Most people assume that 100% means just that – you’re covered for literally everything. Unfortunately, it means something else. Specialists can charge patients what they wish and these fees are often way over what the medical schemes will pay.

These medical scheme rates are what the medical scheme will pay for treatment, and most entry-level medical aid plans pay for in-hospital expenses at 100% of the scheme rate. If your specialist charges far over this 100% which is nearly always what happens, you’ll have to pay for that excess amount – that is if you don’t have gap cover. If you have heart surgery, this can amount to thousands upon thousands of Rands.

Make the Gap Less – Why is Gap Cover so Vital

Of course, there are always a couple of ways to lessen the gap between what health care providers charge and what medical aid schemes pay. One of these is to only make use of network doctors – those contracted into your scheme’s medical rates.

Gap cover is of critical importance to medical aid members. It is a separate insurance product that has been created to take care of the shortfalls between the medical aid and the medical specialist. It is of utmost importance to have gap cover if you don’t want to drown in medical bills. One additional positive aspect with gap cover is that it is miraculously affordable too.


Fill in the form on this page and click on the “Get a quote” button to get a Gap Cover quote.

All info was correct at time of publishing