Estimate How Much Gap Cover You Need

December 19, 2021

How do you estimate how much gap cover you need?

  • Take your current, monthly medical aid payment
  • Add the monthly payment of the gap cover you are considering
  • Compare this to your second choice of a plan offering hospital limits that are unlimited overall
  • Pick Maxi-Care if it works out cheaper


The benefit brochure for your medical aid outlines the benefits you are subject to in the upcoming year of membership. There should be a section that outlines the hospital benefits you are eligible for. A number of them state that your hospital insurance policy does not have an overall limit.

It should be a relief to you should you be a member of such a plan. For some others, their hospital plans do have limits in one form or another. You should estimate the benefits versus the costs.

Estimate yearly hospital limit

What is a yearly hospital limit when it comes to medical aid? It is a cap, beyond which you cannot be treated using your cover. In-hospital costs to be specific, not the cost of seeing a specialist.

Estimate How Much Gap Cover You NeedFor example, let us take a hypothetical man named John. John works for the government and has taken out the Government Employees Medical Scheme (GEMS) Sapphire option medical insurance policy. The upper limit for this policy is a yearly sum of R140,070 per family, in 2011. This means any hospital bills John or any member of his family accumulate over this amount will have come out of his pocket!

Should, unfortunately, John ailing with his 5 member family get involved in a vehicle mishap and require hospitalisation, the basic emergency care will be covered by his medical scheme as a bare minimum benefit that all medical aids are mandated to provide.

This, however, does not qualify all the treatment required by all the various family members will be covered. Should an extended hospital admittance be required by either himself or any of his family members be needed, there are chances John will have to foot some of those costs.

Read the fine print

For those who’s medical aid plans do not have any caps on their annual overall hospital benefit, look out for sub limits in the fine print of the scheme policy document. Some individual benefits may have caps attached, but the policy remain cap free overall.

What can you as a member of a medical scheme that incorporates annual overall hospital limits into its polices? Either pick a hospital plan without limits or acquire gap cover for your medical aid. Just such a product is Maxi-Care by Turnberry, which offers medical aid schemes that feature sub-limits. This includes a per admission medical sub-limit cover of a maximum of R2,500.


Complete and then submit the form on this page to get a gap cover quote


All info was correct at time of publishing