Vital Must-Know Facts about Gap Cover

December 19, 2021

With the rising cost of medical expenses in South Africa, it isn’t surprising that there are reports of medical aid shortfalls.  That’s why you need to know the facts about gap cover.

While medical aid cover is becoming more affordable, the cover does not align with the inflation rates of medical professional consultations or costs of medication.  In certain cases, health professionals can charge up to five times the medical scheme rate. However, most medical schemes only cover you for one times the medical scheme rate. This means you would end up worrying about significant and unplanned medical bills. And that is when you should have peace of mind and focus on recovering and restoring your health.

Naicker on Facts About Gap Cover

“This is the reason gap cover is now on the list as a must-have for most consumers,” says Presodhini Naicker, Head of Brand and Marketing of Old Mutual iWYZE.  Naicker shares 5 vital things you need to know about Gap insurance.

  1. Gap insurance covers the difference between the expenses covered by your medical scheme provider and the actual hospital or doctors bill. For an example, if your medical aid can only cover R12 000 of your R16 000 hospital bill, gap cover would then pay the difference.
  2. Gap cover is not an alternative for medical insurance. Your medical aid will cover most of the cost however due to the fact that medical expenses are unpredictable, they depend mostly on the procedure. For example, a planned natural birth could suddenly turn into an emergency C-section due to medical complications.Facts About Gap CoverC-sections could go up to double the cost of natural birth. With Old Mutual Iwyze, the total maximum compensation limit payable for all In-Hospital, Out-of-Hospital and Benefit Extender benefits has an R150 000 limit per family member per annum.
  3. Compared to medical insurance, Gap insurance pays directly to you and not to the medical institution or practitioner owed. Gap insurance reimburses you for the costs to you of the hospital bill.

  4.  Gap cover has nothing to do with your medical aid. When you change your medical aid provider it does not affect your gap cover. What is important is, you cannot have Gap cover unless you have a medical insurance. Medical schemes are regulated by the Medical Schemes Act 1998. On the other hand, the Long-term and Short-term insurance Act 1998 regulates health insurance.
  5. You can get Gap cover for yourself and also dependent on your medical aid. Meaning you it can cover your whole family who is also on your medical aid.

Medical shortfalls could be caused by long treatment intakes, medical conditions that are not or partially covered by your medical insurance or high specialist costs. Before buying gap insurance, make sure you understand all the facts. Check your current medical aid scheme (most importantly, read the fine print) and make sure the gap cover, literally, fills the gap, giving you peace of mind regarding your health insurance.

Facts about Gap Cover from iWYZE

iWYZE is the direct insurer from Old Mutual providing car, home and life insurance. iWYZE is underwritten by Old Mutual Insure Limited. Reg. No: 1970/006619/06. VAT No: 4460101019. Authorised Financial Services Provider (FSP 12).


All info was correct at time of publishing