Sanlam Gap Cover Insurance for Medical Aid
November 28, 2024
If you’ve got medical aid in South Africa today, you can’t sit back and believe that all your medical treatments and bills will be covered. You need Sanlam gap cover.
When your medical aid tells you that your claims will be reimbursed at 100% of the medical aid rate, that doesn’t mean your claims will be settled in full.
Sanlam shortfall cover will be necessary because specialists submit individual claims at different rates and which aren’t in line with the Scheme’s medical aid rate.
If you have to have gap cover then, it goes without saying that to keep costs reasonable, you’ll need a good medical scheme. The scheme will have to be paired with decent, cost-effective gap cover that 
provides you with the right benefits.
About Sanlam gap cover for medical aid
- You have to belong to a registered medical aid scheme.
- Having medical gap cover from Sanlam comes with a host of awesome benefits. Some of these are having a hospital cash benefit, death or permanent disability benefit and dental reconstruction benefit. Your medical aid premiums will also be covered for up to 6 months in the event of a permanent disability or death of the main member.
- There are different prices for gap cover from Sanlam – anything from roughly R200 a month to R700 a month for individuals, families and those over 60 years of age.
- Sanlam offer in- and out-of-hospital benefits. As an example, in-hospital benefits include among others tariff shortfalls, co-payments as well as deductibles – a type of co-payment that first has to be paid just to be accepted into hospital.
- Sanlam is a leading gap cover provider for under 60-year-olds. The gap cover suits individuals and families, providing for up to an additional 5-times the standard medical scheme rate.
- There are waiting periods – a general waiting period of 3 months on all benefits as well as a 12-month waiting period for pre-existing conditions.
- Some treatments aren’t covered by gap cover. This will include claims older than 6 months as well as claims rejected by your medical scheme. Other treatments not covered are cosmetic surgery, specialised dentisty, although this is included on the comprehensive plan in the event of cancer and trauma.
- If you and your spouse are on separate medical aids, you will be covered by a single Sanlam gap cover policy.
- Medical gap cover from Sanlam is for the main member, their spouse and children up to the age of 27.
- Sanlam top-up cover pays for in-hospital care – not day-to-day medical expenses.
Gap Cover isn’t a nicety to have – it’s a downright necessity in South Africa, where private healthcare rates have increased to become all but out of reach.
Shortfall cover promises lower bills
As a short-term insurance product, gap cover from Sanlam will provide extra protection for those on medical aid, covering the amount your medical scheme’s tariff (MST) is and the rates charged by private healthcare professionals.
You can’t escape the fact that most times, the cost for in-hospital procedures for example is going to exceed the regular amount your medical aid will cover by 5x, maybe more.
By investing in Sanlam Medical Gap Cover Insurance, you at least ensure that you won’t have a huge amount of medical bills so that your family suffers in the long run.
All info was correct at time of publishing