Medical Gap Cover from Sanlam

    Medical aid membership isn’t only virtually unaffordable. It’s full of shortfalls, limitations and co-payments. South Africans are disillusioned with their medical aids. That is because they are paying huge monthly premiums, but not being covered adequately. Medical gap cover such as Sanlam offers has become imperative. Because without gap cover, you’ll be paying huge monthly premiums as well as huge medical bills.

    So that is precisely why the market for gap cover is growing so rapidly in South Africa. Gap cover isn’t a medical aid. In fact it is entirely independent of medical aid policies. And a bit of research will show that you can get gap cover for anything from R95 a month to about R275 a month, depending on features and benefits.

    Medical Aids Pay Baseline Amount – Nothing More

    Sanlam Medical Gap Cover

    Gap cover will pay for shortfalls that happen as a result of treatments from specialists who charge far more than what the medical aids are prepared to pay. There are some gap cover providers in South Africa of which Sanlam is one. They are a huge South African financial services group that started doing business in 1918.

    Their long history speaks of quality and professionalism. Significantly, from R144 each month their gap cover will pay that difference between what your medical aid pays and the rates charged by medical specialists. And Sanlam is the first to tell you that the cost for those hospital procedures might exceed the medical aid tariff by five times.

    Medical Gap Cover from Sanlam

    Gap cover with Sanlam will mean you do not have to pay this shortfall amount out of your pocket. And Sanlam offers two gap cover plans – their Standard and Comprehensive Plan.

    • Comprehensive Plan – R174 each month
      In-Hospital Benefits –
      Sub-Limits – R36 000 per condition or event
      tariff shortfalls – up to 5x medical aid tariff
      co-payments – unlimited for certain procedures
      deductibles – unlimited cover
      Out of Hospital Benefits –
      Tariff shortfalls – up to 5x medical aid tariff
      Co-payments – MRI/CT Scans – unlimited
      oncology – R300 000 per treatment cycle for each beneficiary
      emergency casualty benefit – up to R8 000 per event
      Premature Birth (in 34th week or earlier)- R12 000 per event
    • Sanlam Standard: R144 each month
      In-Hospital Benefits –
      Sub-limits – R13,000 per event
      tariff shortfalls – up to 500% of scheme tariff
      Out-of-Hospital Benefits –

    Emergency Casualty Benefit – accidental only – up to R5,000 per event
    Premature Birth (in 34th week or earlier) – R9 000 per event

    When it comes to gap cover from Sanlam, the maximum entry age is 60. Also, apart from the principal member, a spouse and children up to the age of 27 can be covered. Fortunately, special dependents, for instance, parents over 60 can also be covered by the same medical scheme benefit.

    However, please note that there are some treatments that Sanlam gap cover does not include:

    • Specialised dentistry.
    • Treatment for cosmetic surgery, obesity or breast reconstruction after a mastectomy.
    • Any penalty, co-payment or limit applied by a medical scheme for not complying with the benefit rules.
    • Claims older than six months of age



    Deciding on the right gap cover is important so some consumers use a broker who can explain their policies. Importantly, the gap cover payment is made promptly to the patient, and Sanlam, who have decades of experience, know what their customers need regarding affordable and very necessary gap cover.

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