Medical Gap Cover Exclusions and Other Info

December 11, 2021

The gap, which exists between what is financially provided for by your medical aid and the original hospital costs, requires extra coverage. There are medical gap cover exclusions.

So in the venture of obtaining this additional coverage, you will need to make sure you understand what it entails.

You should also be aware of what it consists of, which revolves around what it covers and not.

It will help you to incorporate the full potential of your monthly premiums.


Medical Gap Cover Exclusions

Medical Gap Cover ExclusionsSo let us look at benefits, by a gap insurance policy, and which they do not cover.

  • This coverage can be connected to any South African medical aid.
  • Also, they insure the excess amount that remains after your medical aid funded their share of the invoice.



So health events that require hospitalisation, which they don’t cover for the first twelve months of your policy, include:

  • Births,
  • Adenoids removal,
  • Grommets,
  • Hysterectomy procedure,
  • Replacing hips, knees and any other.
  • Visiting fees to your general practitioner and any health professional are not in the gap coverage.
  • There is an inclusion of cancerous conditions that they will cover.
  • That, however, depends on the location of where the cancer is.
  • If it is not treated within the procedures of hospitalisation, it, unfortunately, will not be covered.
  • There is no provision for any assistance by any medical aid, as a minimum necessity.
  • It also does not provide cover for any extra costs that are part of your medical event.
  • For these additional charges, you can get another additional coverage option, specifically for these expenses.
  • These costs consist of scans, ultrasounds, admittance fees and a spectrum of procedures in and out of the hospital.


There are a lot of terms and conditions that need to to take into account.

That should not discourage you from taking out a cover.

It is there to provide a service that is not being taken advantage of.

These exist to produce the best possible coverage for any unexpected hospitalised procedures and visitation.

Other Circumstances

Other things that will be excluded from coverage:

  • Events of self-harm, suicidal tendencies or the actual ending of one’s life;
  • Dependency on any medications and any other substance;
  • Heavy drinking;
  • Conditions relating to food, whether it is an obsession in absorbing too much of it or desiring none of it;
  • In the event of you piloting a plane;
  • Taking part in any seriously dangerous sporting events, like rugby or skiing;
  • Venturing into adrenaline driven hobbies, like rock climbing or skydiving;
  • Obtaining glasses for vision-impaired conditions;
  • In dental construction, like a procedure that straightens your teeth;
  • Getting advice for healthier eating habits;
  • Going for any rehabilitation assistance, whether it is physical or mental.


So the above are some of the medical gap cover exclusions.

Ask your insurer for their list so that you can obtain the best service possible.


To get a FREE gap cover quote, complete the form on this page and click on the “Get a Quote” button

All info was correct at time of publishing