The cost of medical attention is soaring. Bring it down with medical aid shortfall insurance.

December 14, 2021

Even if you have one of the best medical aid plans, you could end up in the lurch when it comes to paying medical bills. That’s why you need medical aid shortfall insurance.

It’s not that a medical aid plan won’t pay 100%, but rather that the doctors or hospitals charge more than the medical aid rate.

Add in your annual limits, and it’s not hard to understand how easy it is to run short of cover.

Medical aid shortfall insurance can help cover the deficit for you.

Medical aid shortfall insurance – Can you afford to be without it?

Medical aid shortfall insurance

There are a lot of gap cover plans out there, some affordable, some expensive and some just cheap. It pays to stick with a company that has a well-established reputation.

Affordable, good value cover

Sanlam Gap Cover rates as both affordable and excellent value for money.

As for being an established company, Sanlam is almost 100 years old and is one of the giants of the financial services industry in South Africa.

What will it cost me?

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

Can I join and what are some highlights?

  • You must be a member of a registered South African medical aid scheme.
  • Under the age of 61.
  • You can include individual dependents on the application.
  • The cover is available for your husband/wife/children as long as they are on the same medical plan as you.
  • Your children cannot be older than 27.

What are the waiting periods?

As with all short-term cover, there are waiting periods that apply.

  • You will not have any protection during the initial three months of the policy.
  • Pre-existing conditions or maternity benefits apply only after a year.

What are the exclusions?

It is important to understand what the exclusions are when it comes to your policy. For example, the Dentistry benefit only applies the Comprehensive plan. Not included are elective dental surgery, cosmetic surgery and surgery for weight loss.

The only time cosmetic dentistry or surgery is allowed is when the cause is trauma or cancer.

Only in-hospital expenses are covered and visits to your GP or visits that occur as a result of your everyday medical expenses, are not insured.

Is gap cover for me?

With road accidents and crime rates being as they are, you might be be hospitalised at least once during your lifetime.

How will you be able to afford a shortfall that often exceeds the amount paid by the medical aid?

If you are a member of a medical aid plan and would like a single quote for gap cover for your family, simply just submit the form on this page.

All info was correct at time of publishing