Top Up Cover for Your Medical Aid

December 19, 2021

In South Africa, today everyone needs a hospital plan PLUS top up cover to cover that plan.

Medical aid in South Africa is a lifeline. It gives us access to private health care. Arguably the most expensive of such services is hospitalisation.

But, medical aid schemes don’t cover everything. And specialists can charge some seriously exorbitant rates. Medical aid companies pay out according to the National Health Reference Price List and up to a predetermined limit.

So what happens when there’s a gap between what the medical aid covers and what the specialists are charging? Without gap cover insurance, you have to pay out from your pocket. With gap cover, you have massive peace of mind.

ONLY Medical aid members can apply for a medical gap cover quote by completing and sending the form on this page

More About Top Up Cover and How it can Help You and your Family

top up coverGap cover is a short term insurance policy. This affordable option helps cover the difference that the medical aid pays and what the bills amount to for hospitalisation.

These days’ medical specialists and healthcare providers charge exorbitant amounts. These rates are usually way above and beyond the National Health Reference Price List (now out of date and not compulsory) and are known as private rates.

How Much Does Gap Cover Cover?

The rate at which gap cover will pay out depends on the level of cover you purchase from one of the gap cover companies.

This type of insurance is an optional extra to add to your current medical aid policy. Some gap cover policies start from less than R300 per month.

Depending on your level of gap cover, you’ll usually receive the difference of 100% to 400% of what your medical aid tariff covers.

Let’s say your doctor charges R3 000 for in-hospital services. Your medical aid will only pay R1 000. Your gap cover will then pay the remaining R2 000. Gap cover will only cover legitimate medical expenses.


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You Can Top Up With Cash Plans

Hospital cash back plans are also a popular choice amongst the South African public. They’re popular for their top-up cover for hospitalisation – just like gap cover.

But they’re not the same as medical gap cover. Hospital cash plans will pay you a flat rate per day that you are in a hospital. You can use the money from the cash plan any way you like – be it personal expenses or to cover your medical bills.

These plans do offer good flexibility, but they can fall short if you want to use them as top up cover.

Gap cover is Still the Most Affordable Option to cover rocketing Medical Bills

Gap cover, however, pays out according to medical aid tariffs. So if you’re in a hospital for only a few days, a hospital cash plan might not offer sufficient funds to cover your expenses. What’s more, many of these only start paying out once you’ve been in a hospital for 2 or 3 days.

Just imagine being admitted for a small procedure and you’re in and out within a day. You could still get a big bill that your cash back plan won’t pay out for such a short stay. Gap cover certainly will.

ONLY Medical aid members can apply for a medical gap cover quote by completing and sending the form on this page



All info was correct at time of publishing