Medical Gap Cover in South Africa – Available and Important!

December 10, 2021

Medical aid gap cover in South Africa is  important to medical aid members. That is because it covers the shortfall that exists when the specialist charges too much for in-hospital procedures.

Typical Scenario Requiring Medical Aid Gap Cover in South Africa

Specialists can charge up to 300 or 400% of the benefits offered by medical aid. If your medical aid only pays out at 100% of the tariff, it’s up to you to pay for the shortfall – the other 200 or 300% that the medical aid doesn’t pay.

This is a typical scenario happening with every medical aid member. You can see why medical aid gap cover in South Africa is so important. Where are thousands of Rands going to come from to pay for this shortfall? Do you have an emergency medical fund for these kinds of events?

Medical Aid Gap Cover in South Africa

Some Years are Full of Calamities

There have been cases where people have had two heart attacks in one year. The blood tests they’ve had, the electrocardiogram, the coronary angiography and MRI scans among others have cost thousands upon thousands of Rands.


Let’s say your hospital or specialist charges you far more than what the medical scheme rates are. Then, without gap cover, you will have to pay the shortfall.

Treatment for heart disease also includes medication and lifestyle changes. Be sure that with your medical aid and gap cover you can go full steam ahead with the treatment and medication you require.

A True, Tragic Scenario

Imagine also that over the holiday period you participate in adventure sports, and you have a serious accident similar to that of champion F1 driver, Michael Schumacher? Yes, the public health system may well be able to fix you up temporarily, but can you afford to wait months for surgery?

Can you imagine what months or years of rehabilitation treatment will cost you? Millions of Rands. A severe head injury to the F1 legend has meant a medical bill of £13m. This bill is still climbing after three years of treatment.

Specialists charge what they Like

South Africa is a country where there aren’t any regulations governing specialists, therefore they can charge what they like. When you see that your medical aid will pay 100% for medical treatments, it doesn’t mean your medical aid pays your bill in full.

Specialists charge far more than this 100% rate – sometimes as much as 500% of the medical aid rate. You’re going to be the one left to pay the shortfall – that’s if you don’t have medical aid.

Make Getting Gap Cover a New Year’s Resolution

Medical aid gap cover in South Africa costs anything between R80 and R400 a month. It is designed to cover medical scheme members for shortfalls after a hospital stay. Gap cover isn’t a medical aid. Therefore, it’s a product regulated by legislation covering the insurance industry and not by the Medical Schemes Act.

You can’t invest in gap cover unless you register as a member of a registered medical aid. Anyone who has a medical aid should seriously make getting gap cover a new year’s resolution. Ensure peace of mind surrounding medical care in 2017 depends on it.


For a free gap cover quote just enter your details in the form provided and click on the GET A QUOTE button.

All info was correct at time of publishing