Why Gap Cover is Essential for Medical Scheme Members

February 25, 2022

Medical costs ever on the increase. So it is important to start considering how to cover the gap. Gap cover is essential. If you do not have gap cover, you might have to pay expensive medical bills.

If you are a member of a medical scheme in South Africa, you may believe that you have full cover if you need emergency medical treatment.

You could well be wrong and end up paying the price for that.

You might reach the limits that your medical aid scheme will pay a lot more quickly than you may realize.

Even if they do pay the prescribed minimum benefits as required by law, there is no guarantee that your doctors, etc. will charge standard medical aid rates.

Why Medical Gap Cover is Essential

Therefore gap cover is essential. We list the companies where you can get it below this article.

Gap Cover is Essential for the Shortfall

That is where gap cover is essential. It will pay the portion that the medical aid does not.

Which Company to Choose?

Here is a rundown of the top gap cover providers in South Africa


Here are the 2024 Zestlife rates:

Zestlife Gap Cover 2024


There is cover for procedures done in the hospital in addition to:

  • Costs related to co-payments for treatments in the hospital
  • A lump sum benefit should you be diagnosed with cancer
  • A lump sum benefit should you be permanently disabled in an accident or die in an accident
  • Extended cancer and dentistry cover are optional extras

Use the form on this page to get your 2019 Zestlife gap cover quote.


Cover from Stratum has two plans. Each plan allows for gap cover that is unlimited.

You will have cover for:

  • Costs related to the doctor’s fees and the specialist’s fees
  • Cost related to co-payments
  • The comprehensive plan includes cover for CT and MRI scans and a whole host of other treatments in the hospital.


Look at paying between R79 a month and R124 a month for cover with Turnberry.

Cover provided is up to a maximum of 5 times the medical aid tariff if you lan in the hospital.

You can choose the Elect-A-Care Standard Plan to be covered for:

  • Deductibles
  • Scopes
  • Scans
  • Some scans out of hospital
  • Expenses incurred when in the hospital

The Elect-A-Care Plus plan includes the above benefits plus a range of co-payments for treatments in the hospital and several more benefits for expenses incurred out of the hospital.


Ambledown a premier gap cover product.

They will pay out up to 500% of the standard medical aid rates with a cap of R2 million annually for a family.

Expenses incurred in the hospital are covered.

Cover for outpatient treatments for chemotherapy and radiotherapy.

Outpatient treatments for renal failure are also covered.


The package on offer from Xelus, the Fusion plan, is designed for employers.

The cover extends to shortfalls of any kind.


If you are looking for value for money, this is a great option.

Sirago has no limits regarding age of entry and no limits on an annual basis either.

They also cover optometry and dentistry as long as it is performed in the hospital.


That is basic gap cover.


To get a  FREE gap cover quote, please complete and send the form on this page

All info was correct at time of publishing