Gap Cover Plans FAQ

December 12, 2021

In the process of getting additional coverage there arises a list of gap cover plans FAQ. Some questions can be unique to your personal needs and specifications. The rest, however, will probably correlate with the questions asked by so many before you and those following after you. The following article focuses on these questions.  

What does gap insurance consist of? – Gap Cover Plans FAQ

Gap Cover Plans FAQIt is an insurance that facilitates in assisting you with the excess sum on your medical bill after your medical aid’s share is done. So the invoice contains the total of your hospitalisation, which consists of all charges by doctors. Also, this insurance covers your hospitalised procedure up to five times the original medical aid basic pricing structure. The plan will not exceed 1 million rand per year.

Why is this kind of insurance essential?

Your medical aid, unfortunately, will only advance coverage for a certain amount, which leaves you with an outstanding balance. Also, you have to pay this amount. So investing in this extra (gap) insurance will enable you to cover settling the bill, entirely, without involving your personal bank account.

Does this coverage inevitably insure provision for extra medical fees?

Unfortunately, it does not provide for any extra fees. There is, however, a specified policy that will cater for those additional costs.

What establishes the approved tariffs of medical aids?

There is a medical aid committee that produces a selective coding system, which provides the recommendation of pricing the aid adheres to.

Are determined yearly boundaries valid in the case of gap insurance?

The plan will not exceed 1 million rand per year. There is, however, the possibility of revising this sum at varying time periods.

Does the gap coverage provide for the minimum recommended health assistance?

No, it, unfortunately, does not make provision for the minimum health support, which medical aids instituted.

What is the monthly fee for this insurance?

Here is a 2024 table showing gap cover premiums from Zestlife .

Zestlife Gap Cover 2024


Will the monthly charge for this increase from time to time?

It is affirmative that a possible increase will take place on a yearly basis.  

Does the plan include other added expenses?

Your once-a-month instalment will already include the necessary admin and transitional charges, which excludes the existence of any other hidden expenses.

When do I need to pay the first instalment?

From the first month of coverage, you will start making your monthly payments. The date your payment is due will be listed on the application. Make sure you are confident when your payment is due, to prevent any misunderstandings.

Are there any health check-ups that I need to submit to in being insured for this coverage?

So there is no need for any check-ups. Also, you can get insurance straight away. In submitting a claim, however, there may be specified documentation necessary.

What is the required documentation in submitting a claim? – Gap Cover Plans FAQ

  • Claim request;
  • Doctor’s results;
  • Hospitalisation invoice;
  • Health insurer’s filed claim, approval, participation record;
  • Outstanding balance is due.


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All info was correct at time of publishing