Advice About Gap Cover for Medical Aid Members

December 18, 2021

We have excellent advice regarding gap cover.

Here at Gap Cover Info we have drawn together what you need to know about this valuable form of insurance.

Here is Your Advice

  • Gap insurance is also called co-payment cover, shortfall cover or top-up cover.
  • Usually gap cover kicks in when you incur high expenses for hospital, specialist or other health costs, where your medical aid refuses to cover the whole amount, leaving you with a co-payment.
  • The product means you will not have to make co-payments out of your own pocket.
  • Gap cover is for members of medical aids in South Africa only. For guidance you can refer to the full list of official medical aids here.
  • Having health insurance, such as from Clientele, DOES NOT qualify you for gap cover.
  • Medical gap cover is unique to South Africa. That’s because medical aids are unique to South Africa, and gap cover is linked to medical aid membership.

Does each medical aid member need a gap cover policy?

  • No. A single gap insurance policy will cover every beneficiary or member on your medical scheme.
  • You qualify for gap cover no matter if you are on a cheap hospital plan from a medical aid or if you have comprehensive cover.
  • There are a limited number of exclusions and waiting periods – but nothing unreasonable.
  • Medical aids themselves do not offer gap cover as these are statutory bodies with firm rules, whereas gap cover is short-term insurance.
  • Any gap cover company will insure anyone on any medical aid in South Africa.
  • There are many gap cover companies who specialise in this kind of cover including Zestlife, Sirago and Turnberry.
  • Gap cover is inexpensive. You can expect to pay a monthly premium the equivalent of roughly 5% to 10% of your medical aid premium.
  • You save by having gap cover. In our opinion you should take out gap cover rather than opting for a more expensive medical plan. You will benefit financially overall – and you won’t have to make exorbitant copayments.


Our suggestion is that you start the signing up process for gap cover by using the useful contact box on this page. Complete the fields and then submit the form. An expert will be in touch to counsel you about gap cover membership and send along a quote


All info was correct at time of publishing