Essential Medical Shortfall Insurance Explained

December 8, 2021

Essential medical shortfall insurance Cover pays the shortfall when doctors charge more than medical aid rates.

Most medical aid schemes in South Africa do not fully cover hospital and medical practitioner fees, often creating unexpected financial burdens.

So Essential Gap Covers those unforeseen expenses by up to four times the stipulated medical scheme rates.

These include additional costs for anaesthetists, surgeons and specialists during in-hospital procedures.

Essential Medical Shortfall InsuranceMembers of Momentum, Discovery and Liberty Medical schemes are eligible for Essential Gap Cover, but an application can be made by members of any other South African medical aid.


Submit these documents:

  • Copies of medical practitioner accounts for hospital stays
  • Copies of hospital accounts
  • The Essential Gap Cover claim form


Once claims are verified and approved, funds are transferred electronically to the policy holder’s bank account within about 14 working days.

Do You Need Essential Medical Shortfall Insurance?

So if the answer is yes to any of the questions below, visit the company site and complete the quotation form:

  • Are you a current member of a medical scheme?
  • Is that insurance the only financial safeguard on hand to cover hospitalisation?
  • Thinking about downgrading your medical aid plan to save costs?
  • Worried about a reduction in medical aid benefits and thinking about upgrading for better cover?
  • In the case of hospitalisation do you have access to additional funds?
  • Do you want peace of mind to cover other medical expenses?
  • If the answer is yes to any of these questions, then visit the Essential Gap Cover website for more information.


For a FREE gap cover quote, fill in the form on this page with your details

All info was correct at time of publishing