Essential Gap Cover Solutions

December 14, 2021

Essential gap cover is medical gap cover that Essentialmed offers.

Medical aid schemes in South Africa don’t cover you for 100% of the costs of hospital and specialist fees.

That’s why you need Essential gap cover to cover the extra expenses.

What is Essential Gap Cover?

Essential gap cover pays the shortfall when the medical aid schemes don’t completely cover the services of individual healthcare providers. These include anaesthetists, surgeons and specialists during your hospital stay.

If you are a medical aid member, you can apply for your own medical gap cover quote NOW by completing and sending the form on this page

Whether you belong to Liberty medical aid, Discovery Health medical aid, or Momentum medical aid, you can take out the insurance. In fact, if as you are currently a member of a medical aid scheme, you qualify to apply for gap cover.

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The policy covers the shortfall that results from a difference between the actual rates charged by healthcare providers and medical aid rates. Essential will cover as much as four times of your medical aid rate.

Medical Aid Schemes have Adjusted their Benefits

From Momentum Health to Discovery medical aid, most medical schemes in SA have made adjustments to their benefits. That impacts the amount that you are required to pay for gaps in the payment of services.

Essential Gap Cover

Even some schemes that used to cover members up to 300% of their scheme tariff have cut that back to 200% meaning that without essential gap cover, you could be paying personally.

How the Product works for You –

This is how essential gap cover works: Once your medical aid approves a claim and processes it, you will need to submit these documents to Essential gap cover:

  • Copies of the claims for your healthcare providers during your hospital stay
  • Copy of medical aid statement stating the processing of the hospital account
  • Your essential gap cover claim form

Once you’ve sent these through, the company will assess your eligibility for the claim. Once they have verified the claim, they will prepare a statement for audit for your essential gap cover.

Finally, a payment schedule will be prepared, and your funds transferred electronically. The entire process only takes about 14 working days.

Do You Need This Insurance?

If you answer yes to any of the below questions, it’s worth filling in the form for a gap cover quote:

  • Do you currently belong to a medical aid?
  • Is your health cover the only financial plan you have to cover you for hospitalisation?
  • Do you think you’ll downgrade your medical aid plan to save on costs?
  • Do you worry about a reduction in medical aid benefits and are thinking about upgrading your plan for better cover?
  • If you were to land in the hospital would you be unable to secure additional funds right away?
  • Do you want peace of mind in the event of hospitalisation and guaranteed gap cover payment?


Don’t be left out of pocket just because your medical aid policy doesn’t completely cover you.

If you are a medical aid member, you can apply for a medical gap cover quote NOW by completing and sending the form on this page

All info was correct at time of publishing