What is Gap cover?
Gap cover is short-term insurance that works alongside your existing medical aid. It covers the difference, or “gap”, between what your medical aid pays and what healthcare providers actually charge. Note: Gap cover is not a replacement for medical aid. It only works if you already have one in place.
What does it cover?
Outpatient procedures
In-hospital specialist shortfalls
Medical aid co-payments
Casualty, dental, maternity, and oncology
Emergency transport and ambulance cover
*Gap cover benefits may vary depending on your chosen provider. Most products are subject to waiting periods for new members and annual payout limits typically apply – R 219 845 per insured person per year in 2026.
Why do you need it?
Many doctors and specialists charge above the medical aid rates, leaving you with out-of-pocket expenses. Gap cover helps to bridge this shortfall, protecting you from unexpected medical bills
What to think about when selecting a Gap cover
Consider your coverage needs.
Understand your medical aid coverage, potential shortfalls, and your or your family’s medical needs and history. For example, parents may prioritise casualty benefits for ER visits, while others seek extended oncology benefits for chemotherapy.
Evaluate the premiums vs benefits.
Align the monthly premiums with your budget, while considering the benefits offered. Choose a balance between affordability and comprehensive protection.
Understand the waiting periods.
These differ by product but for most Gap cover products: accidents are covered immediately; there are general waiting periods of 3 months; and waiting periods up to 12 months apply for pre-existing conditions (including pregnancy).
Who’s it for?
Choose cover for yourself (individual), or for your family, including the primary member and their dependents as registered on the same medical aid scheme.