When You Need the Best Gap Cover

December 20, 2021

When looking for the best gap cover, keep the following points in mind when choosing your medical aid gap cover.

Discovery Gap Cover

All Discovery medical aid members can have shortfall insurance just as members of all medical schemes can. In fact, Discovery offers arguably the best gap cover on the market. The cover applies to any expenses you or your dependents incur while in a hospital. Note that these policies do not cover cover day-to-day expenses, though.

What is Shortfall Insurance?

When a healthcare provider charges more than the scheme rate, medical aid schemes will pay the difference between the invoice and the scheme rate. Depending on which of the medical aids in South Africa you belong to, the product pays the costs of treatments, admissions, Prescribed Minimum Benefits and even hospitalisation.

Getting gap cover is easy.

If you belong to a South African medical aid scheme, please complete and send the form on this page and we will send you one complimentary gap cover quote

Some claims through medical aids like Momentum medical aid or Liberty medical aid may be subject to a certain amount of excess. Be sure to read the fine print and also make sure you understand which scheme exclusions apply to gap cover.

  1. Why Do You Need Top Up Insurance?

Often medical aid members will have a shortfall between actual costs and what the medical scheme, such as GEMS medical aid, may cover. That’s because healthcare providers are fully entitled to charge more than the set tariff rate.

Best Gap CoverThat shortfall becomes your responsibility, and you will need the best gap cover to cover such instances.

Some of the more comprehensive medical plans and even hospital plans will cover anywhere between 100% to 150% or 200% of the healthcare practitioner’s tariff rates, but the actual cost could well be as much as 600% of those tariff rates. The best gap cover will cover the difference between what the practitioner charges you and the actual cost of your in-hospital doctor’s bills up to a certain percentage of the tariff.

  1. Who is Eligible for the product?

Anyone who is a member of a medical scheme can apply for gap cover.

  1. Does it matter how big your family is?

No, it doesn’t. But certain products limit the size of the family or have certain age criteria, for example, that all members who are insured belong to a medical aid scheme if they wish to qualify for the best gap cover.

  1. Are there cancellation periods?

Typically there are cancellation periods of between 30 to 60 days depending on the scheme.

  1. Is there a waiting period?

The waiting periods also vary depending on the provider. Waiting periods can range from 0 days to 3 months for certain conditions. These periods usually start on the date of the policy’s inception, but there are exceptions for emergencies.

  1. Are there benefit limits?

Annual benefit boundaries of the policy will vary depending on your insurer.

  1. Is there an excess on benefits?

Some of the plans may have an excess payable depending on conditions such as age.

If you belong to a South African medical aid scheme, please complete and send the form on this page. Then we will send you one free  quote from Zestlife


All info was correct at time of publishing