Is Medical Gap Cover Necessary – Find Gap Cover

December 19, 2021

Here is why you should find gap cover:

  • medical specialists have no regulations for their charges
  • it helps medical aid members cover the risk of medical bills beyond the NHRPL
  • are you able to pay the copayment before you commence with treatment?


Most South Africans look at medical gap cover as a necessary evil. They find it grossly unfair that they pay massive premiums to their medical aid each month, and still aren’t covered fully. They are forced to buy gap cover or else face their terrible financial consequences.

Find Gap CoverAlthough medical gap cover isn’t a medical aid, South Africans look upon it as having to buy additional medical aid to cover the inadequacies of the cover they already have.

Whether you like it or not, if you don’t want to be financially sunk you have to have gap cover.

This means these specialists can charge what they like. Your medical aid will only pay out for what they believe the specialist should charge, and nothing more.

It’s important to do Research to Know the Essential Differences

Gap cover doesn’t form part of your medical aid and is, in fact, short-term insurance.The cost of gap cover varies quite a bit between the different providers, and some really affordable gap cover can cost just R60 a month while others will be R130 a month or more. Gap cover also excludes certain things such as cosmetic surgery, suicide attempts, mental illnesses, taking narcotics as well taking part in hazardous sports.

You’ve got to do research on gap cover. Because there are also different maximum entry ages, with many service providers not allowing you to invest in gap cover if you are over the age of 60 or 65 years of age.

Not Everyone Is Happy with the New Regulations – Find Gap Cover

National Treasury has introduced new regulations which have seen a limit on the amount of gap cover and hospital cash-back policies you can claim. There are some medical schemes in South Africa that believe the changes aren’t wonderful and that customers will pay more.

The medical aid industry is in trouble. All because people are claiming more than ever and not enough young people are joining medical aids, and factors like this have led to higher than usual price increases – far higher than consumer price inflation.

Some Negative Effects – Find Gap Cover

Discovery Health Medical Scheme says that the impact of gap cover on the scheme has been somewhat limited. They say they need to protect themselves from clients who buy down. They have a 2 year waiting period for clients who buy down to cheaper plans.

Medical aid members are unhappy with the high premiums they pay for less and less cover. Gap cover is critically important and yet it is becoming more expensive too and it also has exclusions. There are also concerns that with medical scheme contributions becoming increasingly expensive. Such as private healthcare is out of reach of most South Africans.

Gap Cover – a Glimmer of Hope

Government’s plans to cut gap cover will just leave this market floundering. And the lack of regulation is just causing confusion for  South Africans with the current state of health care in the country.

There is an urgent need for more regulation across the board. Because with everyone in the industry trying to make money, medical aid members are becoming reluctant to stay in the system. They look at medical gap cover as a glimmer of hope in an otherwise dismal scenario.


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All info was correct at time of publishing