URGENT: Do you have gap cover for medical aid?

December 15, 2021

Have you read the small print on your medical aid policy? If not, you might get a shock when you realise that you’re not actually fully covered when you’re hospitalised and that’s why you need gap cover.

Medical aid schemes cover the Medical Scheme Tariff requirements but this almost always falls short of what doctors and specialists charge.

For just a small extra monthly premium, you can take out shortfall insurance that ensures you’re not left out of pocket. Variations on these plans offer 400% to 500% payments, with some even covering 600%, of the medical scheme tariff. Many also offer benefits like co-payment and accident cover.

ONLY Medical aid members can apply for one FREE quote by completing and sending the form on this page

Important Reasons Why You Need Gap Cover Almost Immediately

Why you need gap coverLet’s say you’re hospitalised unexpectedly. You undergo surgery in a theatre with the use of scopes.  An anaesthetist and a specialist will oversee your treatment. You also require in-hospital medication and recovery time.

Your medical aid will cover 100% of the fees during your stay. But usually specialists and hospitals charge as much as 400% more than that.

So who pays for the shortfall? You do. That’s why you need shortfall insurance.

Unlike medical aid, the insurance company will make your payment directly to your bank account. And you can then settle all the outstanding specialist and hospitalisation bills for your treatment

To qualify you need to belong to a medical aid. Your family is included in the cover too, provided they belong to the same medical aid as you.

Not All Medical Aid Policies Have a Savings Account

If you’re with Discovery Health, for example, you may have a simple hospital plan and no medical savings account.

While gap cover won’t cover expenses like day-to-day medical needs, there are those that will cover certain out-patient treatments and scans that you will need to pay for yourself if you don’t have gap cover.

Discovery’s insured network benefit helps to reduce the gap. Once members have spent everything in their savings account, the gap cover will still cover GP consultations, generic medications and pathology. That’s another reason why you need gap cover.

Can You Afford to Be Financially Strapped while You are Trying to Recover?

Don’t get caught out. In today’s rife financial times, you don’t want to be spending your hard-saved holiday cash on emergency hospital bills. Top up insurance is a highly affordable option. Some plans starts from as little as R59 per month for a family of 5.

The top gap cover companies in the country include:


Some gap cover policies will impose a 3 month waiting period or 12 months for pregnancy or pre-existing condition. Some have maximum entry ages and others don’t. All gap cover policies require you to be a member of a medical aid scheme in South Africa.

ONLY Medical aid members can apply for one FREE medical gap cover quote by completing and sending the form on this page

All info was correct at time of publishing