What does gap cover cost?

December 12, 2021

What does gap cover cost should not be the question. The question should be: What do I risk by NOT having gap cover?

Here is the answer:

Are you aware of co-payments? These are the shortfalls that occur in most cases when a medical aid member lands in hospital and needs specialist care.

And these gap payments can amount to several hundred thousand rands.

These bills you have to settle out of your own pocket.

Why do co-payments happen?

Many members of medical schemes ask us this question.

Say your medical aid plan is for 100% cover. You probably think that means you will never have to pay a cent out of your pocket for health bills.

But you are wrong.

That is because the 100 percent figures DOES NOT mean that at all.

Instead it means that the medical scheme will pay 100% of the price for any product or service as it appears on their internal price list.

And this list bears no relation to the actual costs of hospital stays and specialist accounts.

Remember, hospitals and specialists can charge what they like – and they do.

Therefore you might see a mystifying medical plan option from your medical aid mentioning percentage cover of anything from 300% to 500%.

That means a specialist or hospital might charge that much more than apperas in the medical aid price list.

For instance, say a procedure in hospital costs R156 000 in total. And let’s suppose the internal price list of your medical aid is R56 000. Let’s suppose that your plan is for 200 %. That means your scheme will pay 2 x 56 000 + R112 000. And the balance is for your own pocket.

That could deliver a massive shock to your finances.

Enough to put you in hospital.

But how much does gap cover cost?

It’s simple.

Expect to pay roughly the equivalent of 10% of your medical aid premium monthly for gap cover.

We suggest you get your custom quote from Zestlife. You can contact them via the form on this page,

Meanwhile, here are the latest guide prices (2024) for Zestlife gap cover.

Zestlife Gap Cover 2024


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All info was correct at time of publishing