What is Gap Cover?

It is a short-term insurance product that covers the gap amount that occurs during in-hospital procedures, when medical service providers charge more than the medical scheme rate i.e. your medical scheme could pay for up to 200% of their rate, but the doctors often charge up to 500% or more. That gap amount would be for your own account, or can be claimed from Gap Cover if you are a policy holder. This is a product exclusively for members of a registered medical scheme.

Why do you need gap cover?

A shortfall often occurs between what a medical scheme pays and the actual cost of a procedure or treatment.  That shortfall is then the member’s responsibility. There is therefore a need for additional cover to avoid out-of-pocket medical expenses and Gap Cover fills that need.

Who can be covered under your Gap Cover Policy?

A Family is defined as the principal insured person and the eligible spouse, and eligible children, who have not attained the age of 21 years or if an unmarried full-time student who has not attained the age of 25 years, unless mentally or physically disabled and unable to earn any form of income. Any dependants falling under this definition are included at no additional cost.

Can you use Gap Cover in conjunction with your medical aid?

Yes, specific policies can be used in conjunction with any medical aid registered in South Africa.

What is Co-Pay Cover?

Co-payments are an excess amount that are often imposed and specified by the medical scheme. Co-Pay Cover is a short-term insurance policy which would cover these co-payments – including for scopes, MRIs, CTs and ultrasounds.

If you have any questions, please complete the contact form with your details and one of our Financial Planners will call you.