Gap Cover Explanation for South African Medical Aid Members

December 9, 2021

Have you exhausted the funds in your medical aid before the year is out? For most people, the answer to that question would be a resounding yes. Okay, then you need a gap cover explanation.

And that is why you need Gap Cover. Yes you pay out a hefty chunk of cash every month to be a member of a medical aid scheme. But there just never seems to be enough funds available to foot you and your family’s annual health care needs.

Gap Cover Explanation – FAQs about Gap Cover

Why do I need Gap Cover?

You may ask yourself why you need to pay out extra cash every month for Gap Cover when you already pay a hefty premium to a medical scheme. Well, the answer is simple. Without Gap Cover, you are exposing yourself to the very real threat of being handed a medical bill that could spell your financial ruin.

But my medical scheme pays 100% of my medical costs.

No, it doesn’t. All medical schemes only pay the amounts stipulated in your membership contract for a variety of medical procedures and treatments. Members of the medical profession are not obliged to adhere to those tariff rates and it is not uncommon for them to bill you 500% more than what your medical scheme is prepared to pay.

Questions Answered

Gap Cover Explanation

Do I qualify for Gap Cover?

Anyone who is a member of a registered South African medical scheme, like Discovery for GEMS, for example, is qualified to obtain Gap Cover.

Can I afford Gap Cover?

Budgets vary from one family to the next but generally, yes, you can afford Gap Cover. This is a short-term insurance product, not unlike those for your motor vehicle and household cover with monthly premiums starting from as little as R150.

Who is the best Gap Cover provider?

There is no “best” Gap Cover provider. All South African short-term insurers that offer Gap Cover have different monthly premiums and policy benefits that can be tailored to meet your individual needs.

So, how do I go about getting Gap Cover?

Simply complete the form on this page to receive a Gap Cover quote. Another time and cost-efficient method of obtaining a Gap Cover quote is to visit an online platform like Hippo or Informed Healthcare Solutions. You simply provide the details they require and they will streamline your search by sending you quotes from different insurers to suit your personal needs.

Are there exclusions on Gap Cover policies?

Yes. Generally, the following are excluded from cover:

  • Drug addiction
  • Attempted suicide
  • Cosmetic surgery
  • Mental conditions
  • Hazardous professions such as the military and police
  • Injuries sustained in high-risk sports


Are there age limits for Gap Cover membership?

Yes and no. Age limits depend on which insurer you select. Some have an age restriction of 60 years, while others do not but you will generally have to pay a higher premium.

Gap Cover Explanation – Overview

The high cost of healthcare services makes Gap Cover a logical choice to protect your financial security in the event of a medical emergency or needed hospital procedure.

Next step: Please complete and submit the form on this page to get your quote

All info was correct at time of publishing