Where Can I Get Medical Gap Cover?

December 14, 2021

People need to get medical gap cover in South Africa because specialists in South Africa charge fees way beyond those the National Health Reference Price List  (NHRPL) suggests. The List is a pricing system maintained by the Department of Health and the Council for Medical Schemes. It provides rates to which medical aid schemes should follow.

Gap cover pays the shortfall for you when your specialist charges up to 300% above the NHRPL prices. You may think you have total cover for any medical treatment you may require. But with the medical schemes of South Africa, for the most part, you aren’t. Most people are completely taken off-guard when they receive a medical bill for thousands of Rand that their medical aid didn’t pay.

If it is so important, where do I get it medical gap cover?

Get Gap Cover Insurance

Get Medical Gap CoverGapCover is a short-term insurance product. It is for anyone who is on a medical aid, providing extra cover for medical shortfalls.

There are some companies offering gap cover in South Africa, and we’ll look at 1 or 2 of them –

  • Complimed – they were formed in 2003. They have created short-term insurance products to help members pay the shortfall.
  • Zestlife – we like Zestlife’s Universal Gap Cover enhancements:



  1. Overall regulatory maximum for medical expense shortfall cover increased from R150 000 to R160 000.
  2. Cancer lump sum increased from R25 000 to R30 000.
  3. Casualty benefit increased from R10 000 to R20 000. Casualty visit must be within 48 hours of the accident.
  4. Medical Aid and Gap Cover Premium Waiver maximum increased from R6 500 toR7 300.
  5. Medical Aid and Gap Cover Premium Waiver limited to accidental only, but the payment period increased from 3 to 12 months. This change was due to legal requirements.
  6. Accidental dentistry maximum increased from R15 750 to R19 250 and amount per tooth increased from R2 250 to R2 750.
  7. Non-Designated Service Provider co-payment increased from R8 600 to R9 300.
  8. Oncology co-payment maximum increased from 20% to 25%.
  9. Cover for robotic procedures up to R30 000.
  10. Cover for procedures in day clinics.
  11. New Oncology Benefit to cover 20% of treatment cost when oncology limit is exceeded.
  12. Varicose veins have been added as an out-of-hospital procedure that is covered.


Zestlife’s 2024 Premiums

Zestlife Gap Cover 2024


You need to be a member of a medical scheme to qualify for gap cover. If you are a medical aid member, please complete and send the form on this page to get a gap cover quote


More Places to Get Gap Cover

  • Ambledown – an underwriting agency and leading health insurance product provider with more than 150,000 gap cover policyholders.
  • Stratum – Stratum Gap cover benefits are comprehensive. Stratum covers the following shortfalls – 500% tariff gap – basic shortfall for in hospital. The plan is called BASE 500 because it pays the difference between 100% up to 500% of the tariff.


You DARE not be without Gap Cover

There are many other companies where you can get Gap Cover. Prices differ so do research. The main thing to remember is that whether you like it or not, the way medical aid works in South Africa, you have to have gap cover if you don’t want to sink financially.

If you are already a member of a medical aid, then complete and send the form on this page to get a FREE gap cover quote

All info was correct at time of publishing