Gap Cover for Selfmed Medical Scheme

December 18, 2021

As a Selfmed medical scheme member, gap cover is something that you may or may not have heard of. People sometimes  regard it as a “nice to have” rather than an essential form of insurance. If you have a medical aid or a hospital plan, gap cover might seem superfluous to your needs but bear with me for a minute. Gap cover is just as vital as your Selfmed medical aid when it comes to protecting your future health.

What is Gap Cover?

It is, essentially, short-term insurance to cover shortfalls that may exist between the bill you receive for in-hospital procedures and what the medical aid pays. So, let’s say your medical aid covers you 100% for your hospital stay, then gap cover will pay for the rest.


It is a bit confusing – after all, doesn’t the fact that your medical aid pays 100% of the in-hospital account mean that your whole bill will be paid?

You would think so, wouldn’t you? But you could be very wrong.

Look at the wording of your policy – does it say 100% of Recommended or Standard Medical Aid Rate? Sounds superb, doesn’t it?

Selfmed Medical Scheme

Except that specialists and hospitals do not, by law, have to charge the same rate. In fact, they will usually charge more – as much as four or five times as much.

And guess who has to pay that extra money? That’s right – you!

Why as Selfmed Medical Scheme Member Do I Need Gap Cover?

Hospitalisation is expensive these days. It is a good idea for everyone on all medical aids to have gap cover. You never can tell whether or not you are going to be in an accident or when you will need emergency care. Considering that we are talking of thousands of Rands in bills here generally, most people will not be in a position to pay any excess amounts.

Who Qualifies for It?

Anyone who is already a member of a registered medical aid such as Selfmed medical scheme can apply.

Is Gap Cover Expensive?

Depending on what coverage option you choose and where you get the cover from, the cover is reasonably affordable. You can opt for a very basic option that only covers emergency expenses or get a more comprehensive policy that will cover things like cancer treatments and specialist dentistry as well.

Will There Be a Waiting Period?

Yes, there will normally be a waiting period. The waiting periods differ depending on the gap plans themselves but, in general, you will need to wait at least three months to be able to claim in most instances.

If you have a pre-existing condition, the waiting period will be determined by the company. Most companies will not cover pregnancy expenses during the first year that the policy is in place.

Are There Going to be Exclusions?

Again, this is going to depend on the plan that you choose and the company’s policies. In most companies, there is a maximum age after which you can no longer join up.

What Happens When I Claim?

Regarding South African law, the monies paid out to cover a claim must be paid to the policyholder directly and may not be paid to the service provider.


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All info was correct at time of publishing