FAQ for Gap Cover

December 16, 2021

Here is a useful FAQ article that will help you to understand gap cover.

FAQ 1: Can I have both Gap and Medical Aid Cover?

Yes. In fact, gap cover is solely for members of any registered South African medical aid scheme.

Furthermore, you can enjoy flexibility when opting for both gap and medical aid cover. It means that you don’t have to get these forms of insurance from the same service provider.

  • Example

You can have gap cover from Momentum and medical aid cover from Discovery or any other registered medical scheme.

FAQ About Gap Cover

Unlike medical aid cover, a Gap policy is a form of short-term insurance that pays the difference between your medical aid scheme’s pay-out and the actual end-cost of the treatment billed by the medical profession. This is a crucially important factor to remember. That is because medical aid schemes work according to prescribed maximum pay-out benefits for various medical procedures and treatments. Andthese usually fall dismally below the actual end-cost to the patient.

FAQ 2: How much will it cost me?

The cost of gap cover varies depending on the product and company selected.

  • Example

A basic gap cover policy for a family of four can cost as little as R250 a month.

However, a top-of-the-range product from the same company can cost R700 a month.

Our best advice is to shop around for a gap cover policy that suits both your individual needs and financial constraints.

FAQ 3: Do I need gap cover?

With the exorbitant cost of medical care, there can be no doubt whatsoever that everyone who is a member of a medical aid scheme needs to complement those benefits with a gap cover policy. Your medical scheme may offer cover of between one to three hundred per cent but, in reality, the medical profession can charge you up to 600 times more than your medical aid scheme’s stipulated cover benefits. This shortfall can amount to untold thousands of Rands and leave you burdened with a debt you cannot afford to repay.

Remember, there is no government regulation of South African healthcare providers. They are free to charge whatever they want for their services.

Gap Cover is affordable and is a small price to pay for the peace of mind it will give you and your family.

FAQ 4: Can you explain the fees that are charged by the medical profession?

The best explanation for the anomalies that exist between medical aid tariff rates and fees charged by the medical profession is to give you an example.

  • Example

At today’s rates, it costs in the region of R26,000 for a caesarean section. Medical schemes, however, may only offer to pay one-third of that cost, leaving you with a shortfall in the region of R17,000! Very few people have that kind of ready cash lying around but, with gap insurance, you will be covered for the full outstanding balance.

FAQ 5: Are exclusions built into gap cover policies?

There are exclusions. These may vary from one insurance provider to another but generally include:

  • Attempted suicide
  • Cosmetic surgery
  • Depression
  • Drug abuse
  • Injuries sustained from participating in high-risk sports
  • Medical care related to the aviation, military or police professions
  • Mental illness
  • Stress-related ailments


FAQ 6: Are there any age limits?

Age limits also differ from one insurance provider to another. Some cap their age limits at 60 years, while others offer gap cover for senior citizens but at escalated monthly premium costs.

Request your  gap cover quote by completing and then submitting the form on this page

All info was correct at time of publishing