The Meaning of Gap Cover for Medical Aid

December 18, 2021

The meaning of gap cover for medical aid in South Africa is fairly easy to make sense of. But before you read on, know one thing: this type of insurance is for members of registered medical schemes only. So if you only have health insurance, such as a product that pays out a set amount per day when you are in hospital, gap cover DOES NOT apply.

What is the meaning of gap cover?

Gap cover for medical aid in South Africa is specialised short-term insurance that pays out the difference of what your medical aid will pay if you land in hospital and need specialist care, and the amount that actually appears on the accounts from your service providers.

The Meaning of Gap Cover

How does gap cover work?

  1. Ensure that you belong to a registered medical scheme in South Africa such as GEMS, Discovery, and Selfmed.
  2. Ask for quotes from gap cover companies, such as Zestlife. These companies are totally separate from the medical schemes themselves.
  3. Sign up for gap cover. Fortunately this is inexpensive insurance, amounting to premiums of 5% to 10% of your medical scheme premium. That’s good value for money.
  4. Should you or any other beneficiary on your medical aid be faced with medical co-payments, the gap cover company will pay the cash in question into your account so you can settle your bills.

How does one make a gap cover claim?

Your gap cover company will help you. The gist is that you complete an online form and then collect all the required documentation from your health providers e.g. doctors, hospitals, specialists. The requisite cash amount will be paid into your personal bank account.

Are there instances where gap cover is not important?

The trouble is, no one knows what health expenses one will face in the future. It could be that you will need cancer treatments. These are outrageously expensive and your medical aid is unlikely to pay for everything, unless you are on an extremely expensive executive plan. So cover your bases, take care of your family. Opt for gap cover to make sure you are not bankrupted by medical bills.

Complete and submit the form on this page to sign up for immediate gap cover

All info was correct at time of publishing