Medical Aid Shortfall Insurance from Sanlam

December 19, 2021

Obtain Medical aid Shortfall Insurance from Sanlam from R166 a month.

People also call the product medical gap cover.

Gap Cover pays the difference between stipulated medical scheme tariffs and rates charged by the medical profession.

Medical aid members often see bills of up to five times more than what their medical schemes will pay.

This can apply to in-hospital or outpatient treatments.

Sanlam’s Gap Cover ensures that policyholders have cover for these financially crippling additional medical costs.

Who Qualifies? – Medical Aid Shortfall Insurance from Sanlam

Medical Aid Shortfall Insurance from SanlamExisting members of registered medical aid schemes

Also available to families with children up to the age of 27 years

So you need to register all family members with the same medical scheme

Entry level limits up to the age of 60 years

In addition, Sanlam makes allowances for the inclusion of special dependants

Waiting Periods

  • All benefits – three months
  • Pre-existing conditions – 12 months
  • Maternity benefits – 12 months



Obesity, including bariatric surgery (stomach stapling)

  • Cosmetic surgery unless a result of trauma such as oncology treatment (breast reconstruction after a mastectomy)
  • Co-payments that are not in rand amounts (i.e. when applied as a percentage)
  • Also, penalties, co-payments or limits imposed by medical schemes for non-compliance with benefits rules or authorisation procedures. It also includes hospital procedures without prior approval by the medical aid or using a non-network hospital.
  • Specialised dentistry is only paid in the event of trauma, cancers or tumours



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 or read more here 

How To Claim – Medical Aid Shortfall Insurance from Sanlam

  • Claims transaction receipts from medical schemes
  • Copies of accounts from medical practitioners
  • Hospital accounts including the first four pages showing admission/discharge times and ICD codes
  • Current medical scheme membership certificate (copies of membership cards are not accepted


Members will receive an e-mail and SMS when:

  • The claim is in.
  • Outstanding documentation is requested, such as authority forms
  • The claim is authorised and ready for payout


Payments go directly into the principal member’s bank account.


Complete and submit the form on this page to get a family gap cover quote

All info was correct at time of publishing