What Medical Gap Cover is Best?

December 9, 2021

It’s difficult to say what medical gap cover is best because South Africa has some excellent gap cover providers. Gap cover is a short-term insurance product. It doesn’t form part of your medical aid. It  will cover the shortfall between your medical scheme’s tariff and what the specialists charge.

Medical schemes offer to reimburse specialists at 100, 200, 300, 400 and 500% of the scheme rate. But just paying 100% doesn’t remotely mean that the medical aid will pay your medical bills entirely. With most medical treatments there will be a shortfall, and you’re the one who must pay this shortfall. By subscribing to gap cover, you can at least protect yourself from having to fork out money for massive medical bills out of your pocket.

What Medical Gap Cover – You MUST belong to a Medical Aid Scheme

Anyone who has signed up with one of South Africa’s registered medical aid schemes can invest in gap cover. Unfortunately for many older people, you have to be less than 60 years of age when you first apply for gap cover. Benefits, however, extend to your spouse and dependent children.

You’ll find that then you’re looking for the best medical gap cover, there will be waiting periods and

What Medical Gap Cover is Best

exclusions. Typically you can expect a 12 month waiting period for pre-existing conditions. It can be a bit unsettling knowing that during these waiting periods, you won’t have cover.

Exclusions refer to those procedures the insurance company does not include in your gap cover. Because these exclusions vary between the different gap cover providers, you need to find the gap cover that will suit you best.

When you look for the best medical gap cover and read people’s reviews, you’ll see that quite a few people recommend going with Stratum and Complimed. There are so many gap cover options available to you in South Africa that we look at a few reasons why people choose gap cover from Stratum.

What Medical Gap Cover – We Look at Stratum

  • Stratum will tell you that their sign-up process is as easy as 1, 2, 3 – you can expect this because their gap cover benefits are well thought out and comprehensive.
  • Their gap cover includes a co-payment cover which takes care of in-hospital procedures related to co-payments.
  • Oncology Benefit – with most medical aids today, there is a sub-limit for the treatment of cancer, so that when you reach this limit, there will be a co-payment of about 20% depending on the medical aid you are on.
  • 500% tariff gap – this is the basic shortfall you get for the hospital. With Stratum this is known as the BASE 500, paying the difference between 100 – 500% of the tariff.
  • Sub-limit – sub-limits appply to certain in hospital procedures as well as prosthesis’. This benefit is included in Stratum’s Elite Option.
  • Premium Waiver – this benefit is included in the Elite options and pays for your premiums for a certain period when you’ve been retrenched for instance.


South Africa has some good gap cover offers and we’ve mentioned two. Customers seem to agree that these two work well for them, and there are others as well. Do research and get gap cover…it’s no longer regarded as a pleasant addition to your medical aid but has become a critical necessity.

If you are a medical scheme member then get your medical gap cover quote. Just complete and send the form on this page

All info was correct at time of publishing