Necessity for Medical Gap Cover – Sanlam Simeka Health’s View

December 18, 2021

Medical gap cover is available to anyone who is a member of a registered medical aid. And the necessity of medical gap cover cannot be disputed.

Gap cover isn’t a nice add-on to medical aid. In these times it has become an absolute necessity. Sanlam was founded in 1918 and  they are a  financial services group that offers gap cover.

Necessity for medical gap cover – it pays for what you can’t pay

When your medical aid only covers a certain percentage of your medical treatments, then it it left to you to pay for the shortfall.


Necessity for Medical Gap Cover


That is precisely where gap cover comes in – it does what you cannot do. It covers the shortfall so that you are not ruined financially.  Sanlam themselves is a top-ranked gap provider in South Africa so their view is worth taking note of.

Always check out co-payments and sub-limits

Gap cover is a huge necessity, according to Sanlam, because without it you will have to be bombarded with co-payments and sub-limits. In fact, if you look at gap cover, you want to be sure to check out their co-payment benefit, their oncology cover and their sub-limit benefit extender.

Small wonder that thousands of South Africans are seeing the importance of gap cover. Doctors and specialists can charge up to 4 times that of the medical aid tariff, and this amount that goes over the tariff is the shortfall. It’s what you will pay if you don’t have gap cover.

Necessity for medical gap cover – A guideline for medical procedure costs

The way these prices work is that there is the National Health Reference Price List or NHRPL. Each year the government releases the NHRPL and it is supposed to serve as a guideline for rates.

Medical aids make use of the list to determine how much they will pay out. It seem as though each year they pay less and less and increase their premiums more and more.

Without gap cover, unless you’re a power ball winner, there is no way you can pay the excess amount of medical procedures as it can amount to thousands of Rands.

A simple tonsillectomy can have you reeling

A simple tonsillectomy where you are in and out of hospital in a jiffy can set you back by  a few thousand Rand without gap cover. However, with a critical procedure such as heart valve repair and replacement surgery, all the costs involved can set you back literally tens of thousands of Rand.

You could be facing a medical bill of more than R200 000 and even more. It is why Sanlam re-iterates the necessity of medical gap cover.

Gap cover hasn’t been dealt with

It was in December 2016 that National Treasury promulgated the latest version of the Demarcation Regulations. Existing health insurance products had to comply with the regulations by January 2018.

The DR gave the green light for the insurance industry to provide gap cover in co-existence with medical schemes. This gap cover is a contentious issue as medical aid members feel that now they are pay two premiums each month. They feel government hasn’t addressed these issues.

Medical insurers make this gap cover available to complement medical aids provide medical aid members with  protection against health-related risks.

Choose your gap cover with great care

South Africa has many reputable gap cover providers and your financial adviser can help you in choosing the best gap cover.

When you see the absolute havoc that can come about without medical gap cover, for a fairly low  premium each month, it is worth having gap cover. The necessity to get yourself this lifeline gap cover as soon as possible has never been greater.

Use the form on this page to request your free quote.
Remember to hit the “Get Quote” button. Act now!

All info was correct at time of publishing