Gap Cover Explained

December 15, 2021

Has your medical aid cover not lasted the full year this time round?  Can you even remember a year when it did? Gap Cover Explained takes a look at the issues.

Most households with medical Aid in South Africa use either private or state health care providers and pay large out of pocket expenses every time around.

So who can get shortfall cover? Whether you are with Discovery medical aid, GEMS or any of the other myriad of providers in South Africa, as long as you have medical aid you can get gap cover. Just put no medical aid, no gap cover.

Medical aid members can apply for a top-up insurance quote for the whole family by completing and sending the form on this page

An Essential part of well-being

The general cost of living is high, and medical costs are rising all the time. So an unplanned hospital admission, even if it’s only to the emergency room, can be a shock to family finances. Gap cover can be a welcome help in these circumstances.

Gap Cover ExplainedHow Medical Aid Members Benefit

Look at this for an example of what costs are. A young couple planned a family for some time during the next 12 months.

She fell pregnant almost straight away having set up a meeting with their financier to discuss medical needs for the planned pregnancy.

They had already heard about gap cover and took out a policy, treating it as a shortfall insurance policy while they sorted out their longer term needs.

Costs that Weren’t Covered by their Plan

In this case, pregnancy costs were outside of their regular medical insurance provision, so gap cover made good sense for them especially as they had an older child who needed medical treatment during the sibling pregnancy and Dad broke his collarbone and required hospital admission to treat the problem.

Are You in Need of this insurance?

Before you answer, you need to know how gap cover works. To start with it is a shortfall that covers gaps in your main medical insurance.

You don’t need to belong to a particular medical aid provider to enjoy gap benefits, but you do need some form of policy in place already.

You can keep gap cover in place, even if you decide to change the provider of your primary policy.

The insurance will not pay out for costs associated with the following:

  • Drug abuse
  • Plastic surgery
  • Self-harming
  • Suicide attempts
  • Injuries from hazardous sports
  • Aviation costs
  • Military or policing injuries
  • Stress-related illness and mental health costs

Bear in mind, gap cover is often dependent on an entry age. Some service providers limit cover to those below 60 years while others have no age limits.

Get Gap cover explained to you if you are unsure of what a gap policy can do for you and your family.

Medical aid members can apply for a quote by completing and
then sending the form on this page

All info was correct at time of publishing