Why Should You be Thinking of Getting Medical Gap Cover?

December 19, 2021

there are several good reasons to get medical gap cover if you’re thinking of getting it.

  • only some of the better medical aids will pay up to 300% of set rates
  • you’re the one who has to pay for the extra costs unless you have gap cover
  • medical plans have  limits to what they will pay for treatments
  • your medical aid is most instances not going to foot your entire bill


Gap cover is a form of short-term insurance that pays for some, but not all, medical expenses exceeding what your health plan will cater for. You need to compare medical gap cover because there are different maximum ages at which you can take out gap cover policies. If you’re older than 60 or 65 you may not be able to take out gap cover with some gap cover providers. Then again there are some gap cover providers such as Guardrisk who don’t have a maximum entry age.

Life is Never Predictable – Thinking of Getting Medical Gap Cover

Accidents and illnesses call for you anytime. How many people haven’t sat in a doctor’s room to hear the terrible news that they have a dread disease such as cancer?

Unfortunately, most medical aid policies, even those where you pay a massive premium each month – set limits on how much they will pay out for treatments.

You will first have to establish how much your medical aid covers so that you know how much gap cover to choose. How many people haven’t been involved in an accident and had their lives irrevocably changed so that they can no longer work?

There are many gap cover providers in South Africa and each one offers products that will make up the shortfall that exists when medical aids don’t pay up in full. Because your medical aid says it covers you 100%, you may think that you are fully covered by your medical aid, but you aren’t.

Most specialists charge above-recommended scheme rates and your medical aid isn’t going to pay for this surplus amount. You will have to foot the bill.

You Save Big Time with Gap Cover – Thinking of Getting Medical Gap Cover

One of the biggest benefits of having medical gap cover is the significant savings you can enjoy. Look around you and you’ll quickly discover the ever-increasing cost of medical treatment. Because of the lack of legislation in the industry, you’re going to have to pay specialists large sums of money – unless you have gap cover.

Experts in the health industry will tell you that ideally, you should be looking for 500% or 5 times medical aid rates of cover as well as for gap cover that covers co-payments. This is seriously a key benefit as nearly all medical schemes use co-payments when members go to a hospital.

Zestlife 2024 Gap Cover Premiums

Zestlife Gap Cover 2024


Don’t Take Any Chances – Thinking of Getting Medical Gap Cover

Yes, some doctors contract with the medical scheme and don’t charge above the specified rates. This is why it is important for the medical aid member to check things like this with the doctors performing their procedure.

Gap cover is mercifully a fairly simple concept in South Africa but it can become complex when you try to budget and still get something worthwhile. Then maybe it is in your best interests to rather consult with an expert who can guide you about making the best choice.


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All info was correct at time of publishing