What is Gap Cover?

December 20, 2021

Have you ever felt yourself wondering, why, after a period in hospital, your medical aid didn’t cover the full cost of your stay? Yet you thought you were covered for 100% and now find yourself asking, what is gap cover?

Medical aid is scattered with small print and it can be a minefield for the regular client out there who’s just looking to sign up for some sort of cover and peace of mind. And all that person wants to know is that as long as he’s paying his monthly premiums, he’s covered in the event of an accident and even day to day medical expenses.

But if the average Joe doesn’t want to find himself bankrupt over extra costs that he only finds out about after being discharged from hospital, it’s time to look at what is gap cover?

What is a Gap Cover?

What is gap cover

Whether you belong to Discovery medical aid; Momentum Health or any other medical aid, each scheme offers different benefits and types of medical aid shortfall insurance. And costs will vary too depending whether you want to take out policies from firms such as:

  • Ambledown
  • Zestlife
  • Complimed
  • Discovery
  • Stratum


When choosing your insurance, make sure look into exactly what is gap cover. And understand what it means when you don’t 100% cover for a medical treatment.

If you belong to a South African medical aid scheme, please complete and send the form on this page and we will send you one FREE quote

What the Insurance Covers

  1. Say your GEMS medical aid says you’re covered for 100% or even 200% of hospitalisation.
  2. So here’s the thing: specialists aren’t actually regulated as to what they charge for their services so they might charge more than 100% or 200%. And that means you need to pay out of your own pocket.
  3. Fortunately, gap cover in South Africa is a type of short-term insurance that will help you cover those expenses.
  4. The cost of shortfall insurance is reasonable. A whole family can get a policy for around R400 a month.

Get one FREE quote by completing and submitting the form on this page

When looking into what is gap cover, you need to understand is doesn’t form part of a medical aid membership. Different laws regulate them.

Gap cover is a valuable thing to have. Even if you belong to a scheme that pays out 300%. So while the medical aid reimburses you specialists or hospital directly when you are in the hospital, gap cover will refund you directly. You can find online insurance quotes for what is gap cover.

We’ve covered what is gap cover, so let’s look at the claiming process. So it’s separate from your medical scheme and typically you submit a claim after the scheme has paid the service providers.

With gap cover you can downgrade your medical scheme option and still keep the insurance.
You can even change medical aids and keep your policy.

If you belong to a South African medical aid scheme, please complete and send the form on this page. Then we will send you one free quote




All info was correct at time of publishing