Choosing a Gap Cover Provider Should Be Easy – But It’s Not

December 18, 2021

Medical gap cover is complicated. Those who try choosing a gap cover provider it out say that there is never ever a light bulb moment when it becomes clear.

You expect medical aids to have complex rules. Top up cover should surely be a lot simpler, but it’s not. For starters, gap cover has all the terminology that medical schemes have.

Gap cover operates on the principle that it only pays out for anything on your medical aid. It’s those procedures that are excluded from full payment because it costs too much for the medical aid to pay.

Choosing a gap cover provider is easier when taken for a group

Medical gap cover for a group is typically cheaper than the cover a person takes out privately for themselves. The reason for this is that a group is getting the cover wholesale as such, so all the costs of selling etc are spread across everyone.

Choosing a gap cover provider in South Africa

Martin Neethling of Sanlam says that this group gap cover can be up to 60% cheaper than individual cover. Whether you are a group or an individual there are some things about medical gap cover that you must look at seriously.

Choosing a gap cover provider: Co-payments

These are a scourge for every medical aid member. Some medical aid members go into shock when they require medical treatment. They are told that they can’t have it unless they first pay a medical aid co-payment fee upfront.

These co-payments usually apply to specialist medical procedures. They differ from one medical aid scheme to the next. It is for this reason that it is imperative to do thorough research on both medical aid and gap cover.

Many South Africans opt for medical gap cover to take care of these co-payments that could stand in the way of them getting the treatment they need.

Tariff gap cover

Tariff gap cover is short-term insurance. It gives you that extra protection when your specialist sends you a bill that is way higher than what the medical aid will pay. In other words, it covers the excess amount that occurs between what your medical aid will pay and what you are charged by medical professionals.

Medical aid schemes reimburse specialists at 300% of the scheme rate, but medical specialists can charge up to 5x the base tariff if they like. By subscribing to tariff gap cover, you can avoid these huge out-of-pocket medical expenses.

Waiting periods and exclusions

Waiting periods and exclusions apply to gap cover. You’ll always find a general waiting period of 3 months and a 12-month waiting period for pre-existing conditions.

This means that during these waiting periods, you aren’t eligible for cover. Exclusions are those procedures and treatments not covered by gap cover benefits.

Choosing a gap cover provider: Oncology benefits

Everybody dreads cancer and this oncology benefit is one of the top benefits that people check out when looking for the best gap cover there is.

You can benefit from the likes of radiotherapy, chemotherapy and specialists’ consultations among others. If you are diagnosed with cancer, you must register for the Oncology benefit.

Sub-limit extender benefits

Health is everything and sometimes you just need that additional treatment. With sub-limit extender benefits you can benefit from superior- or extended treatments without having to part with massive out-of-pocket payments.

When it comes to medical gap cover, as consumers, you want value for the money you part with. A medical aid plan is a huge, important investment and so is the gap cover that you have to have as well.

There are many gap cover providers in South Africa and their benefits and costs differ a lot so make 100% sure that your gap cover option is exactly what you need for your health and for your budget.


Complete and submit the form on this page to get your easy, quick gap cover quote.
NOTE: medical gap cover is for medical scheme members in South Africa only


All info was correct at time of publishing