Gap Cover

Gap cover is an insurance product that is highly recommended to medical aid members. It works alongside your medical aid scheme, although it is a separate product that must be arranged through a gap cover provider.  It is designed to cover the ‘gap’, or shortfall, between your medical aid scheme and the rates of private medical professionals. In this way, you avoid any major, and sometimes unexpected, medical expenses that your medical aid does not cover.

The Benefits of Gap Cover

Gap cover offers coverage for any in-patient or out-patient expenses that may not be covered by your medical aid scheme. This can include anything from co-payments to hospital admissions to medical scans, tests, procedures and more. As a medical aid member, your gap cover will pay for these additional costs up to a certain amount per scheme member per year.

Gap cover is usually inexpensive and only requires one payment to cover all the members of your medical aid plan. This makes it an affordable option, especially if you have several dependents on your plan.

Gap Cover Exclusions

While gap cover does cover the shortfall between your medical aid and private medical professionals, there are exclusions, which will vary depending on your provider. Typical exclusions include cosmetic surgery, cosmetic dentistry and obesity treatment, among others. Sometimes, gap cover does not include co-payments, claims older than six months, etc. Therefore, you should always read and understand the terms and conditions of your gap cover so you have a clear idea of what is and isn’t covered.

Who Can Apply for Gap Cover?

If you are a medical aid member and 60 years and younger, you can apply for gap cover. Gap cover benefits extend to all member of your medical aid scheme, including your spouse and dependents up to a certain age. Your dependents should be on the same medical aid plan and will receive the same benefits as the main member. It is worth noting that there could be a three month waiting period before all gap cover benefits kick in, although this waiting period could be extended to up to 12 months for those with any pre-diagnosed conditions.