Gap Cover
Top up your Medical Aid with GAP cover
Members of any medical scheme can protect themselves against medical expense shortfalls by taking out Gap Cover, which provides additional cover for costs not fully paid by their medical scheme.
Who’s Covered
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Cover is available to members of all registered medical schemes.
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The policy covers the main medical scheme member as well as all dependants listed on the medical scheme.
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Single medical scheme members under the age of 55, where only one life is insured on the policy, qualify for a reduced monthly premium.
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An over-65 premium applies if the main medical scheme member or any dependant is 65 years or older.
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There is no maximum entry age restriction
In-Hospital Cover
In-hospital medical expense shortfall cover pays the difference between what medical specialists and doctors charge and what your medical scheme pays, subject to policy limits.
Cover is calculated based on combined doctor and specialist fees of up to 5 times the medical scheme tariff, less the greater of:
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The amount paid by the medical scheme, or
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The medical scheme’s stipulated tariff for those services
This helps protect you against large out-of-pocket expenses when specialists charge above medical scheme rates during hospitalisation.
Medical Scheme Co-payment Cover
This benefit provides full cover for upfront co-payments that are charged in Rand amounts, rather than as a percentage, by medical schemes. These co-payments typically apply to hospital admissions, specialised scans, and certain surgical procedures.
Non-Network Co-payment Cover
This benefit provides cover for upfront co-payments charged by medical schemes when members use a non-network hospital or medical practitioner. Co-payments may be expressed as either a Rand amount or a percentage.
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