Cover for medical expense shortfalls and co-payments
Plans for individuals, families and seniors
Why Gap Cover?
Medical aid does not always cover 100% of your specialist or doctor's bill. Medical schemes may only cover 100% of their tariff which can be lower than your specialist or doctor's rates. You are liable for the shortfall which can run into the thousands and even tens of thousands of Rands. This is where gap cover can make a difference. It will help cover these medical expense shortfalls and even assist you with cover for certain co-payments. With the high cost of private healthcare in South Africa, gap cover provides financial protection when medical aid alone is not enough.
GAP COVER OPTIONS
INDIVIDUAL COVER
- Individual member
- Up to 500% of medical aid tariff
- No maximum entry age
- Co-payments and scan cover included
- Up to 50 out-of-hospital procedures covered
FAMILY COVER
- Main member + medical aid dependants
- Up to 500% of medical aid tariff
- Senior medical aid dependants covered
- Co-payments and scan cover included
- Up to 50 out-of-hospital procedures covered
SENIOR COVER
- Main member + medical aid dependants
- Up to 500% of medical aid tariff
- No maximum entry age or age-related termination
- Co-payments and scan cover included
- Up to 50 out-of-hospital procedures covered
FREQUENTLY ASKED QUESTIONS
Can anybody sign up for gap cover?
Gap cover is ONLY available to medical aid members. You must be a member on a registered South African medical scheme and you cannot have gap cover on its own without medical aid cover. Members on other types of health cover, like medical insurance, do not qualify for gap cover.
Will gap cover include my dependants?
Yes. Family cover will include the main member as well as adult and child dependants who are on the same medical aid plan. These family policies cover all dependants for a single fee and even senior dependants maybe included depending on the plan that you choose.
What is the cost of gap cover?
Premiums vary for individual, family and senior plans. It also depends on the gap cover insurer. Individual plans may range from R317 per month to R426 per month, depending on the level of cover. Family plans typically start from R398 per month while senior plans may cost R454 or more per month.
How do I claim from gap cover?
The claim process varies among gap cover insurers but is streamlined to be done online or through email. Usually your medical aid statement along with the provider's medical invoice must be submitted to your gap cover insurer who will then assess the claim and pay valid claims.
When are gap cover claims paid?
Gap cover claims are typically paid within 10 to 14 days but can sometimes take up to a month. It depends on the nature of the claim and the efficiency of your insurer in assessing and processing valid claims. It is important to note that gap cover pays only after your medical aid has paid their portion of the bill. Both medical aid and gap cover payouts occur after the procedure.