Why You Should Have Gap Cover

Everyone should have Gap Cover.

The biggest motive to have Gap Cover policy is two-fold.

Firstly, Gap Cover allows clients to sleep easy at night because they know that any extra hospital fees will be paid for by their short-term insurance.

Secondly, Gap Cover may also cover Co-Payment expenses. This is when a member has to pay his/her medical scheme upfront for a part of the costs involved with a surgical procedure.

Medical schemes only pay recommended tariffs, and these are often up to 500% less than what the medical profession will charge a patient. Many people want to have Gap Cover so that they can rest easy.

Why You Should Have Gap CoverExamples

  • Joint replacements – potential shortfall of R18 180 payable by Gap Cover
  • Caesarian  – potential shortfall of R7 158 payable by Gap Cover
  • Childbirth – potential shortfall of R6 870 payable by Gap Cover
  • Tonsillectomy – potential shortfall of R1 776 payable by Gap Cover

What Are Co-Payments?

These are excess amounts charged by medical aid and the financial responsibility of its members. Co-Payments include MRI and CT scans, ultrasounds and scopes.

Co-Payment Examples

  • Hospital procedures for wisdom teeth can cost members up to R5 250
  • Gastroscopies can cost members up to R3 900
  • MRI and CT scans can cost members up to R2 900
  • Hospital admission fees can cost members R1 200

Furthermore, Co-Payment benefits are an additional option and therefore subject to extra Gap Cover fees.

Finally, it covers in-and-out-of-hospital procedures, admission fees and scans.

Who Qualifies to Have Gap Cover?

  • Only members of a registered South African medical scheme qualify for Gap Cover
  • New applicants cannot be older than 70 years of age
  • The principal member, his spouse or life partner and all children listed as dependents on the same medical scheme receive Gap Cover

Also, Gap Cover members can also change from one scheme to another without being subject to a waiting period.


If you are a member of a medical aid you can apply for gap cover today. Complete and submit the form on this page. Then we will send you a quick quote



All info was correct at time of publishing