Various Kinds of Medical Gap Cover in South Africa

December 19, 2021

Medical aid membership in South Africa is horrifically expensive. But in a country like this, people will go without luxuries to be part of an excellent medical aid. The alternative – landing up in a government hospital and your funeral following soon after. Yes, there are some fairly decent state hospitals in South, but few and far between. Even belonging to a medical aid does not mean you can get decent hospitalisation. That’s why various kinds of medical gap cover are available to South Africans today.

Even though people pay a tidy sum to belong to medical aid, there are glitches. You’ll discover that medical schemes do not cover most treatments in full. So over and above your huge premiums each month, you now have to pay partly for your treatments too. That is where the various kinds of medical gap cover come in. It is a short term insurance that covers the gap between what your medical aid pays and what doctors and specialists charge.

Kinds of Medical Gap Cover – Do Research and be Informed

There are many good gap cover companies around that will pay this shortfall for you. For a small premium each month, you won’t be financially crippled by medical bills your medical aid won’t pay.

Kinds of Medical Gap Cover in South Africa

Some of these companies are –

Gap cover products can be difficult to compare but worth it. A while back when gap cover first came out, it mainly filled just the gap between what your medical scheme pays the specialist and the high costs the specialist charges. Today, gap cover products pay the difference between the medical scheme rate and what the specialist charges. In calculating the gap, the insurer limits the practitioner’s charge to 2, 3, 4 or event five times the scheme rate.

Know your gap cover and how it works – they’re not all the same. You could have a payment gap if you opt to use your choice of hospital instead of what the medical aid wants. There could also be instances where in the hospital they charge you for a host of services which your medical aid looks upon as unnecessary. Some gap covers won’t pay for this.

Kinds of Medical Gap Cover – It Doesn’t Pay for Everything

You could also have gap in your medical aid plan for your hospital bill if your scheme has an overall annual limit on the cover but your bill is much more. You’ll find there are gap cover providers who offer a Hospital Excess benefit that covers this particular shortfall.

Same gap covers have a list of procedures they cover on their gap policies which members and some of these procedures include hernia ops, cancer and renal dialysis among others.


Gap cover is important because there are now medical schemes which have even started limiting their cancer benefits. That is so they can control costs as more and more people battle with cancer. You’ll get a gap cover provider like Complimed who have introduced cancer sub-limits at an additional cost and which is designed to pay the shortfalls in cancer treatment beyond those covered by their tariff gap cover. Stratum also offers a sub-limitation cancer cover benefit.

There are different kinds of medical gap cover in South Africa. And it’s up to you to find out which one makes the most sense to you and can spare you financial loss.

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All info was correct at time of publishing