Gap Cover FAQs

December 11, 2021

Can you have Gap Cover and Medical Aid Cover?

Gap cover faqs 1: Yes. In fact, you can have gap cover with one insurer and medical aid from a different provider. But you can only get medical gap cover if you are a medical aid member!

Gap cover essentially is a form of short-term insurance to make up for any shortfalls between your medical cover’s limits and the cost of your treatment.

The difference between the two products is the fact that they are regulated by two different government bodies. Medical schemes fall under the Council for Medical Schemes while gap cover is overseen by the Short-term Insurance Act.

Medical aid members can apply for one FREE medical gap cover quote
by completing and sending the form on this page

How much will it cost me?

Gap Cover FAQsGap cover faqs 2: There is no one standard price for gap cover.  As you shop around for a provider and a plan suitable for you, you will find that the costs for this cover vary quite a bit.

The more the benefits, the more you will have to pay in premiums.

Here is an illustration of Zestlife’s premiums for 2024:

Zestlife Gap Cover 2024


Do I need gap cover?

Gap cover faqs 3: You’re probably already paying premiums for life insurance and other kinds of policies besides your medical aid premiums. On top of your monthly bills and the ever rising cost of food and other material needs, it may be tempting to forego gap cover.

However, consider how helpful its benefits can be in real life. The possibility of the cost of your treatment overshooting the limits of your cover is very real.

In South Africa, healthcare providers are not regulated by the government regarding what they charge for treatment. They, therefore, charge beyond the medical scheme tariff.

Gap cover faqs Example –

A caesarian section can cost about R12,000. Scheme rates for the procedure range at little over R4,000. Imagine your relief if all you had to do is put in a gap claim for the extra R8,000 instead of depleting your savings or having to borrow?


Among the conditions excluded from gap cover are:

  •  Cosmetic surgery
  •  Injuries from dangerous sports
  •  Injuries from attempted suicide
  •  Complications from drug abuse
  •  Aviation, military or police duty
  •  Mental illness, stress-related ailments and depression


Are there age limits?

This differs from provider to provider. Some have an age cap of 60 while others don’t have an age limit.

Medical aid members can apply for one FREE medical gap cover quote
by completing and sending the form on this page

All info was correct at time of publishing