Medical Cover – Are You Over-Insured?

December 17, 2021

Over-insured for medical cover with your medical scheme membership? We think not. In fact, when it comes to medical cover, you can never be over-insured.

Modern-day South Africa dictates that without the financial umbrella of gap cover to protect you from unforeseen costs involved with medical care, consumers leave themselves vulnerable to financial disaster.

The uncontrolled spiralling cost of medical attention by private sector practitioners has opened a can of worms for all members of medical schemes who believe that their costly monthly premiums are sufficient to cover all their medical needs. Nothing could be further from the truth.

Why you can’t be over-insured

Medical aid schemes all operate according to a set schedule of tariff rates for various in-hospital and outpatient treatments and procedures. Unfortunately, those tariffs fall dismally below what the private medical sector charge for their services. In fact, shortfalls between medical scheme pay-outs and medical professional fees can brankrupt the average man-in-the-street.

Let’s take a look at what medical cover products are available on the market today.

Medical Aid Cover

South Africa has a number of companies that offer medical aid cover and among the leaders in this field (in no particular order) are:

  • Discovery Health
  • Bonitas
  • Profmed
  • Fedhealth
  • Medihelp


Depending on the level of cover chosen, their comprehensive medical aid plans range from cover of 100% to 300%. Consumers are often misguided by these cover ranges, believing themselves to be fully insured against any medical event. However, what that cover range actually means is that the medical scheme will pay the percentage chosen from their scheduled tariff rates, all of which fall well below what private sector medical practitioners charge for their services.

An Example

Over-insured for medical cover. Nope.
A black haired lady nurse

For example, a consumer with a 100% medical scheme cover plan is charged five times more than that amount by his professional practitioners for an in-hospital procedure. He has to find the difference between what his medical scheme pays out and what he has been charged for the procedure. This can lead to financial disaster as most South Africans do not have large amounts of ready-cash available in their bank accounts.

Hospital Plans

Many people who cannot afford the luxury of medical aid opt for a hospital plan that offers lower monthly premiums.

A hospital plan is best suited to healthy families whose medical needs are minimal. It provides basic medical cover and usually offers insurance against 26 prescribed medical conditions.

Gap Cover

Gap cover is anessential ingredient in the healthcare mix.

This is an affordable short-term insurance product that fills the gap between medical aid pay-outs and medical profession fees.

Monthly premiums range from around the R350-mark for families and, depending on the company selected, cover is also available to seniors at an elevated monthly cost.

Gap cover, however, is only available to consumers who are members of a registered medical scheme.

To obtain a quick medical gap cover quote, please complete the form on this page.

All info was correct at time of publishing