Cover the gap your medical aid leaves.
Specialists and private hospitals often charge more than your medical scheme pays. Gap cover is an affordable policy that pays the shortfall, so an in-hospital bill does not land on you.
We look at your medical aid and your gap cover together, not in isolation. That way we can see exactly where your plan stops and gap cover picks up, so there are no fall points in between.
How gap cover works
Your medical scheme pays up to its own tariff. In hospital, specialists often charge well above that tariff. Gap cover is a separate policy that pays the difference, so the shortfall does not come out of your pocket.
You are admitted to hospital
Your treatment goes ahead as normal on your medical scheme.
Specialists charge above tariff
Surgeons, anaesthetists and other specialists often bill several times the scheme rate.
Gap cover pays the shortfall
Your gap policy settles the difference between the account and what your scheme paid, up to the annual limit.
What gap cover pays
The shortfall on specialist bills is the main reason people take out gap cover, but a good policy reaches further than that. Here is where it steps in.
In-hospital shortfalls
When a surgeon, anaesthetist or specialist charges above your scheme tariff, gap cover pays the difference, usually the largest part of an unexpected bill.
Co-payments and sub-limits
Covers the co-payments and sub-limits your scheme applies to certain procedures, like scopes, scans and joint replacements.
Enhanced cancer cover
Tops up your oncology benefit once your scheme’s cancer limit is reached, at the point you need it most.
Casualty and extras
Depending on the plan, cover can extend to casualty visits, medical appliances and premium waivers.
Why you need gap cover
Medical schemes cover the basics well, but in-hospital specialist bills are where families get caught. One admission can leave you tens of thousands of rand short, even on a strong plan.
You cannot plan for it
There is no way to predict which admission or procedure will leave a shortfall. Gap cover means you are ready either way.
No scrambling when it counts
A shortfall usually lands while you are recovering. Gap cover settles it, so you are not chasing funds at the worst possible time.
Small premium, big protection
For a modest monthly amount, gap cover stands between your savings and a large, sudden medical bill.
Who we place gap cover with
