What is Copay Cover?

December 16, 2021

Copay cover is part of your health insurance plan. It is where the insured pays a set amount for health care services. Insurance providers charge these co-pays for services such as a visit to a doctor or prescriptions drugs. Most of South Africa’s open medical schemes impose co-payments on certain procedures, which means members could benefit from cover against these co-payments.

About CoPay Cover

  • It’s available to those up to the age of 70 – these people have to be a member of a medical aid.
  • Copay cover benefits the primary member, their spouse and children.
  • A co-payment isn’t going to cover those penalties that resulted from the member not abiding with scheme rules.
  • Insurers make copay cover claims payments when your medical scheme charged a co-payment for an in- or out-of-hospital procedure.
  • The co-pay cover is also subject to exclusions.


Pay Up or Else No Treatment

Most medical aid members aren’t even aware of co-payments until they require a particular medical treatment. It is a fee that the member must pay just for making use of certain medical services. The member has to pay a certain portion of the medical treatment services before the medical aid pays their share.

The co-payments can differ from one medical aid to the next, and mostly apply to certain medical procedures and specialists. When you want to join a medical aid, preferably join one that doesn’t require co-payments from the member.

Copay Cover in South Africa

Many South Africans don’t have the means to pay for these co-payments. If you’re not going to get any help from your medical aid, you’d have to look at medical gap cover which will take care of these co-payments for you so that you can go ahead with treatment.

There’s a Reason behind Co-Payments

Understanding medical aid gap cover, as well as co-payments, is important when you’re shopping for medical aid plans. Good research will reveal to you the different options. Though the co-pay is often just a small portion of the cost of the medical service, for cash-strapped South Africans it is just more money that they have for medical care.

These co-payments are designed to prevent members looking for medical care when it may be regarded as unnecessary. If there wasn’t a co-payment, it is believed that people would abuse their medical aid benefits.

Disgruntled? Nothing’s Changing Yet

Many South Africans who are sick of medical aids. They pay a fortune each month on their premiums, and then they still have to make a pre-payment before they commence with some treatments. They think it is ethically unacceptable for doctors and hospital to ask for payment of fees before treatment regardless of the urgency of the patient’s need for treatment. Some members of a medical aid can die because they don’t have the co-pay amount.

Co-Pay Cover Opens Doors

Unfortunately, you can be as sick of medical aids just like everyone else, but nothing is going to change soon. The only way to overcome these sort of problems is to invest in gap cover. Gap cover is there to ensure you have cover for these frustrating co-pay amounts so that you can proceed with treatment.Gap cover is there to ensure you have cover for these frustrating co-pay amounts so that you can proceed with treatment.

Copay cover is a critically important component of your medical aid as it opens doors to treatment you could not otherwise afford.

To request a medical gap cover quote, please complete and submit the form on this page

All info was correct at time of publishing