Gap Cover Health Insurance from Total Risk

December 14, 2021

How does gap cover health insurance Total Risk Work?

  • It covers the difference between medical expenses and what the medical aid pays
  • Policies range from R155 to R290 per month
  • All policies cover up to 700% of what the medical aid pays
  • Your family is added at no extra charge
  • The annual limit is R150 000 per individual per year


Do you think that your medical aid will cover you in full if you go into hospital? Well, they may, and they may not. It all depends on how closely what you are charged matches the medical aid’s tariffs. (What they believe should be paid for the procedure.)

Unfortunately, these rates seldom match at all and you could find this out the hard way when you have lodged a claim.

How Big Could the Gap Possibly Be?

That depends on what procedure you go in for. You would think that there would not be much of a difference between Gap Cover Health Insurancemedical aid rates and the provider’s fee, but you would be wrong about that.

The gap between what the medical aid pays and what providers are charging is increasing and can be three or even four times what the standard medical scheme’s rates are.

Protect Yourself with Gap Cover Health Insurance

By taking out gap cover health insurance to cover the shortfall, you are protecting your financial future and that of your family as well.

What Total Risk Gap Cover Health Insurance Offers

Total Risk has three basic levels of cover, Vital Cover Plus, Super Cover Plus and Absolute Cover Plus. Each gap cover health insurance policy provides a different level of cover, but the following are applicable to all:

  • There is no age limit when it comes to entry.
  • You are covered, as are other family members listed as dependents on your medical aid. That’s pretty standard when it comes to this kind of insurance. What is not standard is that the company will allow you to include your legal spouse on your policy, even if you are not both on the same medical aid.
  • Cover is extended immediately for emergency procedures, such as the removal of the gallbladder, an appendectomy, a tonsillectomy. Some elective procedures such as vasectomies and sterilizations are also covered as long as the medical aid has paid its portion.
  • The insurance includes cover for Prescribed Medical Benefits when the medical aid has not paid in their portion.
  • The annual limit of R150 000 per person is enforced at all levels of cover.


What Else You Should Know

You must currently be a member of a medical aid in order to qualify for gap cover health insurance. This is an adjunct to your medical instead of a replacement for it.

Your actual coverage will depend on how the medical aid views your original claim. Have they paid the portion they were meant to, or have they rejected the claim completely? In cases where this is due to you not complying with the rules of the scheme, your gap cover will not pay.

When it comes to protecting yourself financially, planning for hospital expenses makes sense and doesn’t have to cost you an arm and a leg.

Next step: If you are a medical aid member, please complete and submit the form to get a quick quote


All info was correct at time of publishing