What can you do in 2022 to avoid medical co-payments?

    December 20, 2021

    Having medical aid is great, but it takes you only so far. Every medical scheme member knows the feeling of receiving a co-payment bill for you to pay out of your own pocket. Gap cover can eliminate co-payments.

    What can you do to avoid that?

    Gap cover is the answer!

    Having extra medical cover as an add-on to your medical aid means eliminating out-of-pocket co-payments should you land in hospital for specialist care.

    But do you really need gap cover? What if you were caught in a pandemic and had to stay in hospital, incurring personal medical expenses on top of what your medical aid would pay?

    And how often has your medical aid lasted all year? Can you boast even one year that you didn’t have to pay a single cent for any health related services?

    Most SA households that have medical aid still have to pay cash for medical costs each year. It makes no difference whether they choose to use public or private healthcare in South Africa. And that’s because they don’t have shortfall insurance.

    Who Qualifies?

    It doesn’t matter whether you’re with Discovery medical aid, Genesis medical aid or any other medical aids in South Africa. So long as you belong to a registered medical scheme, you can get this kind of cover. No medical aid in SA, no gap cover.

    Avoid Co-Payments by Using Gap Cover Insurance

    Gap Cover South Africa

    We all know that the general cost of living, as well as medical aid contributions, keep rising each year and an unplanned trip to the emergency room can be a very unwelcome and unforeseen for shock financially. That is why having insurance to top up your medical aid can help.

    Let’s take a look at an example: a couple planned to fall pregnant within the year and when they succeeded pretty much immediately; it was a little bit of a shock.

    They’d only just set up a meeting with their financier to discuss their needs with regards to having a baby. As luck would have it, they asked to learn more about gap cover and everything gap cover South Africa entails and then decided to take out a policy – kind of like taking out shortfall insurance.

    If you belong to a South African medical scheme, then you can get one FREE medical gap cover quote by completing and sending the form that appears on this page!

    Generally, pregnancy would fall under the pre-existing conditions list and a pregnant couple would be subject to a 12 month waiting period.

    Do You Need Gap Cover?

    The first thing is to understand how gap insurance works. To begin with, it is a type of shortfall insurance that doesn’t for part of your medical cover. What’s more, you don’t need to belong to a particular medical aid provider to enjoy the benefits of the best such cover in South Africa. But you do have to have some form of medical aid – be it basic hospital cover or a more advanced policy.

    You can also keep your gap cover even if you decide to change medical aid providers.

    Where can you get gap cover?

    There are several major insurers of gap cover, including Zestlife and Stratum gap cover.

    What Does Shortfall Cover NOT Include?

    The majority of gap policies exclude certain claims that can arise from conditions like:

    • Taking drugs
    • Cosmetic surgery
    • Self-inflicted harm
    • Attempted suicide
    • Taking part in hazardous sports
    • Aviation
    • Police or military duty
    • Mental illness, stress-related illness, depression or dementia


    It’s also worth knowing that this kind of cover tends to offer different maximum entry ages. There are service providers who won’t let you take out top-up cover if you’re older than 60, and those that don’t have a maximum.

    If you belong to a South African medical scheme, then you can get a gap cover quote from a leading company here. Just complete and submit the form on this page!

    All info was correct at time of publishing