How to Avoid Medical Aid Co-Payments in South Africa

July 27, 2023

Having medical aid is undoubtedly beneficial, but it may not cover all your expenses, leaving you with unexpected co-payment bills. Fortunately, there’s a solution to this problem: gap cover insurance. In this article, we will explore how you can avoid medical aid co-payments in South Africa and the importance of having gap cover as an additional layer of protection.

Avoid Co-Payments by Using Gap Cover Insurance

What is Gap Cover and How Can it Help? 

Gap cover serves as an add-on to your existing medical aid, providing coverage for out-of-pocket co-payments, especially when you require specialist care during hospitalisation.

It acts as a safety net, ensuring you don’t have to bear the financial burden alone.

During a pandemic or any unforeseen medical event, gap insurance can be a lifesaver, helping you cover personal medical expenses that exceed your medical aid’s benefits.

The Reality of Medical Aid Expenses

Many South African households with medical aid still find themselves paying for medical costs each year, regardless of whether they opt for public or private healthcare. The reason behind this financial strain is the lack of shortfall insurance.

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

Qualifications for Gap Cover

Regardless of your medical aid provider, whether it’s Discovery medical aid, Genesis medical aid, or any other registered medical scheme in South Africa, you are eligible for gap insurance. It’s crucial to note that gap cover is not available without a medical aid plan.

Avoiding Co-Payments with Gap Cover Insurance

As the cost of living and medical aid contributions continue to rise annually, unplanned visits to the emergency room can wreak havoc on your finances. Having gap cover insurance can provide peace of mind during such situations. Let’s consider an example:

Imagine a couple planning to conceive within the year, and they succeed immediately, catching them off guard. They decide to inquire about gap cover South Africa and opt for a policy that functions as shortfall insurance.

Having shortfall cover allowed them to handle the expenses associated with pregnancy, which would have otherwise been subject to a 12-month waiting period due to pre-existing conditions.

Do You Really Need It?

Understanding how gap insurance works is essential. It serves as a type of shortfall insurance that is separate from your medical aid cover. Moreover, you are not restricted to a specific medical aid provider to enjoy its benefits. As long as you have some form of medical aid, whether it’s basic hospital cover or a comprehensive policy, you are eligible for gap cover. The best part is that you can retain your gap cover even if you switch medical aid providers.

Where to Obtain Gap Insurance

Several major insurers offer gap cover policies, and among them are Zestlife and Stratum gap cover. It’s advisable to explore your options and select the one that best suits your needs.


While gap cover offers substantial benefits, it’s essential to be aware of certain exclusions that may vary depending on the policy. Some common exclusions include claims related to:

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

Moreover, gap insurance may have different maximum entry ages. Some service providers might not offer top-up cover for individuals over the age of 60, while others may not have any maximum age restrictions.


In conclusion, having this kind of insurance is a wise decision for anyone with medical aid in South Africa. It provides an added layer of financial security, ensuring you can avoid unexpected co-payments and have peace of mind during challenging times.

If you want to safeguard your financial well-being and protect yourself and your loved ones from unforeseen medical expenses, consider exploring gap cover options and finding the best fit for your needs. Remember, being prepared today can save you from financial stress tomorrow.

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