Where Can I Get Medical Gap Cover?

    September 15, 2016

    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 Medical 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.

    – Gap Supreme R 320 pm
    – Gap Senior R 350 pm
    – If you have the Keycare Medical Aid with Discovery or Medihelp’s Necesse, this covers a host of treatments such as back and neck treatment, joint replacements among others which the medical aid won’t pay. The premium is only R180 pm.
    – The Supreme option is comprehensive and covers gap tariff up to 500%
    – You can download the brochure for each of Complimed’s gap cover options and read from the Complimed website.


    You need to be a member of a medical scheme to qualify for medical 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 Medical Gap Cover

    • Ambledown – an underwriting agency and leading health insurance product provider with more than 150,000 gap cover policyholders.

    – gap cover is in the region of R200 a month
    – the maximum benefit is 500% of the medical aid tariffs
    – the cover doesn’t include Prescribed Minimum Benefits
    – will only cover co-payments with designated service providers
    – gap cover limit is R2 million per annum
    – 12 month waiting period for pre-existing conditions
    – Three-month waiting period for all other instances
    – 12 month waiting period for pregnancy
    – you will need to complete a medical questionnaire before approval

    • 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.

    – Premium Waiver – pays for your premiums for a stipulated period for your beneficiaries on death or retrenchment for instance. Part of the Elite option.
    – Co-Payments – for when your medical aid wants you to pay for the procedure. You pay the first amount, and they pay the rest. Stratum Co-Evolution has the tariff and co-payments.
    – Oncology Benefit – there is a sub-limit for the treatment of cancer, and once you have reached this limit, then you will have a co-payment of about 20%. The Elite benefit has this.
    – Sub-Limit – these are for certain in-hospital procedures. This benefit is included in Stratum’s Elite option.
    – Casualty benefit – for outpatients or casualty
    – accidental death and trauma counselling benefit

    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