Medical Gap Cover Questions Answered

December 16, 2021

Healthcare costs are a force to be reckoned with. And the worst part is paying huge premiums each month and not getting the cover you need. South Africans are angry that apart from medical aid, they have to have gap cover too. Gap cover pays out what your medical aid won’t cover. Gap cover is therefore seen as a necessary evil. And here we endeavour to answer all your medical gap cover questions.

Your Medical Gap Cover Questions Answered

Medical gap cover pays out for all those surgical procedures and treatments not fully covered by your medical aid. There are lots of questions surrounding gap cover, and we answer some of them.

Q1. Who is Gap Cover For?
For anyone registered with a Medical Scheme. So the cover is provided for you, your spouse or life partner, your children and extended dependents.

Q2. Why should I buy Gap Cover?
The costs for medical treatments exceed the base medical aid rate, and by having medical gap cover

Medical Gap Cover Questions Answered

insurance you won’t have these massive excess amounts to deal with yourself

Q3. Do I have to belong to a particular Medical Aid to benefit from Gap Cover?
No, gap cover isn’t a medical aid, but it can form part of any medical scheme. But you must belong to a medical aid to qualify for medical gap cover.

Q4. Where does medical Gap Cover come from?
Guardrisk Insurance Company Limited and several other companies including Ambledown, Zestlife and Complimed provide the policies.

Q5. Can I trust Gap Cover to cover everything that my medical aid won’t pay?
No, there are a few treatments not paid by gap cover. For instance, cosmetic surgery, treatment for obesity, specialised dentistry are just some of the treatments not covered. Also any co-payment or penalty for not complying with the rules won’t be paid either

More Medical Gap Cover Questions Answered

Q6.  I already pay a huge premium each month for my medical aid. How much do I have to now fork out for gap cover?
The amount differs from provider to provider, but you’re looking any anything from R120 a month to about R250 a month.

Q7. What happens if I switch to another Medical Aid?
Gap cover is flexible and is a portable product. So you can change to a new medical aid and your gap cover will transfer to your new medical aid. And remember that you pay your gap cover premium separately because it is totally different insurance from your medical aid.

Q8. Are there waiting periods?
Yes, most medical gap cover schemes have waiting periods and even pre-existing condition exclusions as well as other limitations.

Q9. If my spouse and I have different medical aids, can we have one gap policy?
Yes, it won’t be necessary to apply for two different gap cover options

Q10. I’ve got a new addition to the family – a new baby – can I add him to my gap cover?
Yes, you can add your new baby to the policy before 30 days after birth. However, your policy also has to be older than three months to do this.

Q11. I see I need gap cover, so when does cover commence?
Cover commences as soon as you have paid your first premium.

You Need It

Love it or hate it, the facts are evident. Medical aids are not 100% behind you in paying for your treatments. So the stark reality is that you have to have medical gap cover if you don’t want to fork up the thousands of Rands your medical aid won’t pay.

Request your medical gap cover quote now. Complete and send the form on this page

All info was correct at time of publishing