Gap Cover Claims from Sanlam

December 14, 2021

If you have Sanlam gap cover, you might have to put in gap cover claims from Sanlam following a hospital visit. But what is gap cover?

Going to hospital is not something that we like to consider. It is not something that we expect to happen. As a result, few of us are prepared for it when it does happen.

After all, it’s not nice to think about illness or accidental injury. And anyway, if that does happen, your medical aid will sort out all the bills, won’t they?

What Most People Don’t Know

That is what most people think. And, let’s be honest, that’s what the marketing behind your medical aid led you to believe.

Most medical aids will cover 100% of medical aid tariffs. Some will even cover 200% or 300%. It sounds like you are covered, doesn’t it?

And you are, as long as everyone involved charges in accordance with medical aid tariffs.

Here’s a sobering fact for you, though – medical professionals will often charge at least double or triple this rate. So even if

Gap Cover Claims from Sanlam

your medical aid pays out your claim like it is supposed to, there will still be a significant amount left to pay.

And yes, it is quite legal, and there is not much you can do about it after the fact.

Be Prepared, So You Can Make Gap Cover Claims from Sanlam

Fortunately, you can protect yourself without needing to switch to a much more expensive medical aid.

Sanlam Gap Cover offers the Comprehensive Gap Cover at R252 (younger than 60 years) and R605 (60 years and older).  This includes in-hospital treatment and some out-of-hospital treatment benefits.  Enhanced hospital cash benefits are only available to Sanlam Reality members.

For more information on the list of additional benefits and exclusions please check out the PDF document at SPF757_Gap Cover_Top Performer May 2018

Do I Qualify?

And the joining criteria are not that strict. You won’t need to give everything short of your shoe size for this cover.

You must be:

  • An existing member of a registered medical scheme.
  • Aged 60 or under.


Can I Cover the Whole Family?

You can cover your spouse and dependents who are up to the age of 27 on your policy. Sanlam will consider other special dependents on a case-by-case basis.

Wait Out the Waiting Period

To keep the cover affordable, there is a waiting period of three months for general cover. If you have pre-existing health issues or are pregnant, you will need to wait a year before you are covered for those issues.

No Muss No Fuss Cover

Again, to keep the policy affordable, the cover is basic.

NO cover for cosmetic surgery unless it is necessary as a result of an injury or cancer.

Dentistry is only covered if it as a result of an injury or cancer.

No cover for surgery, such as gastric band, to promote weight loss.

Expenses incurred outside of the hospital are not covered.

To Cover or Not to Cover?

Medical costs in South Africa can be daunting. Costs for normal GPs are bad enough, but when you get into specialist fields, they are astronomical.

Most hospitals require a deposit of a few thousand Rand before they will even admit you. Focus on your recovery rather than how you will pay the bills by taking gap cover. It feels good making gap cover claims from Sanlam or another company. It is the financially responsible choice.

Get your official medical gap cover quote on this page. Just complete and then click to submit the form


All info was correct at time of publishing