Medical Gap Cover – Keeping the Community Covered

December 10, 2021

Medical Gap Cover for Community Health Medical Schemes

You badly need gap cover for community health medical schemes if you’re a member of a medical scheme. You can’t buy gap cover without belonging to a medical scheme. It isn’t medical cover but rather an enhancement to it, paying out those high amounts the specialist charges you and which your medical aid won’t pay.

If you don’t have gap cover insurance, you could be the one who has to withdraw all your life’s savings on these medical shortfalls. Without gap cover, where are you going to find the money to pay for these shortfalls which could amount to thousands of Rands?

gap cover for community health medical schemes

Medical Schemes will Not pay out ALL medical treatments in Full

Medical schemes are the main providers of health care in the private sector in South Africa. These community medical schemes reimburse their members for health care expenses. They operate on a not-for-profit basis but are nonetheless surrounded by for-profit administrative entities.

Unfortunately, these medical schemes aren’t able to pay for all a member’s medical treatments – some they pay in full, some they part-pay and others they don’t pay at all.

Understanding gap cover and its value when supplementing a community health medical scheme is important. When discharging a patient after a stint in the hospital, the last thing they want is to be stressing about the large medical bills coming their way. This, unfortunately, is their lot without gap cover. The stark reality is that having a medical aid doesn’t mean your medical aid is paying your bills in full.

Understanding how Gap Cover Works

In South Africa, medical schemes offer different options for members to choose from. The more features these plans have, the more your premium will be.

Unfortunately, specialists in this country aren’t under any restrictions as to what they can charge patients for their services. The fees they charge are usually way more than the rate that medical schemes are prepared to pay. Gap cover in instances like these is exactly that – an insurance product designed to pick up the shortfall between what your medical aid plan pays and what the costs are that the medical professionals charge.

Medical gap cover certainly isn’t a medical aid. It is rather an additional safeguard to protect medical aid members from unexpected financial burden occurring while in the hospital.

Take Your Pick

Even young and healthy people on a community health medical scheme can be sure of what tomorrow will dish up. Unexpected injuries and illnesses can have a young person in the hospital for weeks or months. So even for them, giving gap cover serious consideration is a must.

If you want information on community health medical scheme’s, get health from a financial adviser from any one of South Africa’s excellent medical schemes. You can take your pick from Bonitas, Discovery, Selfmed, GEMS, Bestmed, Fedhealth, Liberty Health, Genesis and others.

To conclude:

No matter which medical scheme you belong to, medical costs can still burn an enormous hole in your wallet. Without gap cover for community health medical schemes, you can suffer further irretrievable financial loss.  The National Health Reference Price List  (NHRPL) may well be a pricing system which the Council for Medical Schemes provides a guide to prices for medical procedures, but many medical professionals don’t adhere to it.

Face facts – you aren’t financially covered for every medical eventuality in hospital. Check out medical gap cover for Community Health Medical Schemes and know that when a medical calamity befalls you, you can at least ‘enjoy’ being sick for a while because you know your medical bills are taken care of.


For a free gap cover quote, enter your details into the form provided and click the GET A QUOTE button.

All info was correct at time of publishing