What Does Medical Gap Cover Mean?

December 12, 2021

Many people don’t understand medical gap cover, and yet it is important to know how gap cover works. For starters, this type of insurance isn’t a medical aid. It is insurance which supplements your medical aid plan.

You can only qualify for this insurance if you are a  member of a registered medical scheme. This is a short-term insurance product – additional health care cover. Its main purpose is to provide cover for the shortfall between what your hospital and specialist charges you and what your medical aid pays.

  • What Does Medical Gap Cover MeanThis insurance product isn’t a substitute for medical aid
  • Gap cover insures against co-payments or deductibles which could be levied against you by your medical aid
  • It won’t insure you for diseases or injuries because of strikes, labour disturbances, etc. or if you take illegal drugs for instance
  • The purpose of the product is to reduce those out-of-pocket medical expenses paid when members have a hospital stay
  • to join medical gap cover, you simply fill in the gap cover application form on the supplier’s website
  • to participate in any gap cover, you must agree to and abide by certain Terms and Conditions
  • South Africa has some reputable medical gap cover providers such as Stratum, Zestlife, Complimed, Turnberry, Liberty and others.


Medical aids won’t necessarily pay out in full for certain treatments or specialists. This shortfall is many times unmanageable when a sudden critical illness or accident leaves you owing thousands of Rands your medical aid won’t pay. That is precisely the reason so many people need medical gap cover.

When Specialists Charge so much More – What Does Medical Gap Cover Mean

Each year your medical aid sets their medical aid rates, and most medical aids will pay up to 300% of this rate. But what about those hospitals or specialists who charge far more than this 300% of the medical aid rate? If your surgeon charges 500% of medical aid rates, and your medical aid will only cover the first 300%, you are going to have to pay the additional 200%.

Medical gap cover, therefore, works in conjunction with your medical aid. However, you need to understand that gap cover isn’t going to cover anything that your medical aid excludes such as cosmetic surgery. It only tops up the shortfall on procedures which are approved by your medical aid.

Thinking of gap cover? Be extensively covered, and if at all possible, include all the different benefits. You’ll notice that some gap cover offers dental benefits. Do research on the different gap cover providers on a good comparison website such as Hippo, among others.

Gap cover gives you the peace of mind that when a medical calamity befalls you, you’re not going to have to despair about what your medical aid ISN’T is covering.

Quality Medical Treatment which YOU don’t pay for

With medical gap cover from a reliable source, you have the cover, and because the premiums aren’t too expensive, you can have confidence that you can enjoy quality medical treatment without the hefty price tags.

Bull’s Eye Financial Services Group provides quality services to all their valued clients. Bull’s Eye knows there are always important aspects to consider with any financial plan. They know you need to review and adjust your plan according to your changing circumstances. They will advise you on the different choices you have and the best medical gap cover plan to suit your needs.


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

All info was correct at time of publishing