Warning About Your Medical Aid and Gap Cover

December 11, 2021

As a member of a medical aid in South Africa you really should have a medical gap cover policy. Our warning about medical gap cover is this.

If you don’t get it, then landing in a hospital might bankrupt you.

Being a medical scheme member and having gap cover are two entirely separate, yet complementary, things.

So you belong to a medical aid

To have a hospital plan or full medical aid with a scheme registered with the Council for Medical Schemes (CMS) is great. That is a strong health sector with a lot of regulations.

There are many such medical schemes. Some of the famous ones are Discovery Health, Fedhealth, Momentum, Genesis, Selfmed, and Medihelp. Then there are schemes that accept members of particular companies or sectors only – ones like the Pick ‘n Pay medical fund and GEMS for government employees.

Warning Medical Gap Cover Zestlife

Depending on the scheme you belong to, and the plan you choose, the medical aid promises to pay 100%, 200% and even more of your medical expenses. That sounds marvellous in principle.

Our warning

The trouble is that what the medical aid regards as 100% of a cost, for instance, is not necessarily what the specialist or hospital will charge.

As the South African economy struggles more, so the medical aids adjust their rules so that they cover less and less of the costs while charging you more and more. Sound familiar? That is why we are warning about medical gap cover.

That is where gap cover comes in

When you get a medical gap cover quote, the company, such as Zestlife, will ask which medical aid you belong to and what plan you have chosen. Then they will give you a quotation. There is great news about medical gap cover:

  • Anyone who is on a medical aid can get it
  • The policy covers the main member and all dependents on the scheme
  • It is really inexpensive (just get a quote on this page to see)
  • Medical gap insurance operates according to Short Term insurance regulations so it is entirely separate from medical aid


The best news of all is that gap cover will cover any medical aid shortfalls and co-payments in the event you land up in a hospital and require expensive treatment.

There are special deals for heart conditions, cancer and even dental gap cover too.

Get a medical gap cover quote on this page if you belong to a medical aid in South Africa. You can’t be without it.



All info was correct at time of publishing