Gap Cover for Medical Aid from Sanlam

December 19, 2021

For as little as R252 monthly, Sanlam offers Gap Cover for medical aid that will pay the shortfall between your medical treatment and the final amount that your hospital or medical plan will pay. Certain in-hospital treatment or outpatient procedures can exceed your specified medical aid tariffs by up to 500%, leaving you to settle the outstanding amount.

Sanlam’s Medical Aid Gap Cover will relieve you of the financial stress of these in-hospital and out-of-hospital costs, as well as provide you with numerous other benefits. As long as you are already a member of a hospital plan or medical aid and under the age of 60, anyone can apply for Sanlam Gap Cover. Continue reading to find out more about gap cover for medical aid.


Gap Cover Benefits – Gap cover for medical aid

Gap Cover for Medical AidSanlam offers two policies for Gap Cover: the Standard and the Comprehensive plans. Although the actual Rand value will differ depending on the policy you choose, the following benefits are common to both plans:




  • Tariff shortfalls (in-hospital)
  • Sub-limits (in-hospital)
  • Emergency casualty benefits (out-of-hospital)
  • Hospital cash benefits (per-day payments to cover extended hospital stays)
  • Premature birth benefits
  • They also cover death or permanent disability benefits
  • Medical aid premium waivers, which pays for your medical aid if you can not
  • Road Accident Fund assistance


Current Premiums for Sanlam Policies

Sanlam Gap Cover offers the Comprehensive Gap Cover at R252 (younger than 60 years) and R605 (60 years and older).  This includes in-hospital treatment and some out-of-hospital treatment benefits.  Enhanced hospital cash benefits are only available to Sanlam Reality members.

For more information on the list of additional benefits and exclusions please check out the PDF document at SPF757_Gap Cover_Top Performer May 2018

Gap Cover Exclusions – Gap cover for medical aid

The intent of medical gap cover is to cover the shortfalls. Although there are a few procedures that they will not cover.

  • Treatments for obesity, which includes bariatric surgery
  • It will not cover cosmetic surgery unless it is necessary as result of trauma or also oncology treatment.
  • Specialised dental treatment will only be covered on the Comprehensive plan if treatment is needed as the result of trauma or oncology treatment
  • Also, co-payments defined as a percentage of treatment cost will not be authorised (only rand-amount co-payments are accepted)
  • Penalties, co-payments and limits resulting from non-compliance with your medical aid’s requirements will not be paid
  • Also, they will not pay a claim that is more than six months old.


Please also be aware that gap cover does not take immediate effect. The following waiting period applies to both the Basic and the Comprehensive plans:

  • Usually also in a three-month general period.
  • A one year waiting period for existing medical conditions and maternity benefits
  • (Certain pre-existing conditions may preclude gap cover completely).


Buy Sanlam Medical Aid Gap Cover online now, or contact one of our service consultants and discover how we can help to ensure the best medical protection for you and your family.

Fill in and submit the form on this page to get your one free gap cover quote

All info was correct at time of publishing