Premiums for Gap Cover Available in South Africa

March 1, 2022

Gap cover is the difference between the medical fees charged by your unregulated specialist while you’re in the hospital and the amount the medical aid will pay. Premiums for gap cover are not very expensive, but they are vital.

Many South Africans believe that their medical scheme will cover all their medical expenses. This most times isn’t the case. When you need to pay for a particular medical treatment, and it ends up being far more than what you’re going to get back from your health insurance –  that amount is known as gap cover. You could call it an out of pocket expense as well.

Premiums for Gap Cover

A Host of Excellent Gap Cover Providers

South Africans who are wise as to how medical aids work, and also how much their medical gap will be, have learned to ask their specialist about their fees before their treatment. Your doctor should reveal these costs to you. Once you’ve discovered how few medical aids there are that pay your treatments in full, you’ll want to find out about a good gap cover provider.

South Africa has some excellent gap cover providers.

Some of these are:

– Complimed
– Stratum
– Xelus
– Ambledown
– Essential Gap Cover
– Turnberry and others

Here is an example: Zestlife’s 2024 Premiums

Zestlife Gap Cover 2024


Whatever monthly premium you pay with these gap cover providers, gap cover is a product only available to those people belonging to a registered medical scheme.

The premiums differ from provider to provider, but nonetheless, the responsibility lies with each gap cover member to ensure that they pay their premium and collect the debit order successfully. If the debit order isn’t successful, a 2nd debit will be run the next month including the arrears and the new month’s premium. The medical aid provider will cancel the policy if there are problems with the 2nd attempt.

Increases, but still Affordable

Gap-cover providers do increase their premiums annually, but even so, gap cover is still cheap. At the beginning of 2016 however, some of the larger providers of gap cover such as Xelus increased their premiums from 6 to 18% percent.

There is no regulation on how much specialists can charge you. A spokesperson from Complimed says that doctors are charging far more than medical scheme benefits because they’re aware that their patients have this gap cover and that they will pay for this cover. In fact, doctors and hospitals are wanting to know whether medial aid members do in fact have gap cover.

Gap cover protects you in those instances where you have a gap in your medical costs. With medical aids not paying the full amount for your medical treatments in the hospital, gap cover will pay for it.
Most hospitals charge 100% the NHRPL price for their facilities. In this case, the medical aid will settle them in full.

It’s STILL within your Means

While gap cover is still so affordable, get it. The affordable monthly premiums for gap cover you pay can save you from a lot of financial anguish. Having to pay for medical bills when you deplete your coffers can be a problem.


For a FREE gap cover quote enter your details in the form provided and click on the GET QUOTE button.

All info was correct at time of publishing