Auto & General Gap Cover ( 🇿🇦 2025)

Overall, Auto & General Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those with medical aid. Auto & General Gap Cover starts from R99 ZAR. Auto & General has a trust score of 4.1. Auto & General Gap Cover has three plans to choose from:

🔎 Auto & General Plan	🥇 Essential Gap Cover	🥈 Comprehensive Gap	🥉 Absolute Gap
🟥 Under 65 (based on the oldest beneficiary) premium per policy monthly	N/A	R295	R510
🟧 Premium per individual per policy monthly	R99	N/A	N/A
🟨 Premium per family per policy monthly	R180	N/A	N/A
🟩 Over 65’s (based on the oldest beneficiary) premium per policy monthly	R360	R495	R710

Auto & General Gap Cover - 11 Key Point Quick Overview

Auto & General Gap Cover at a Glance

🟥 Date Established	1985
🟧 Underwriters	1Life Insurance Limited
🟨 Headquartered	Johannesburg, South Africa
🟩 The average number of members	1,000+
🟦 Number of Markets	1
🟪 Market Share	<5%
🟥 The number of plans offered	3
🟧 Is a Mobile App offered	Yes, Apple, Android, and Huawei

Auto & General Gap Cover for medical aid - Advantages over Competitors

💙Choosing Auto & General Gap Cover comes with a long list of Advantages. These include:

✅ Auto & General Gap Cover offers protection against medical expense shortfalls that may occur during hospitalization.
✅ Members can access unlimited coverage for in-hospital specialist fees, with a 700% reimbursement of medical aid rates.
✅ The policy includes cover for co-payments, deductibles, and other out-of-pocket expenses.
✅ There is no overall limit on the number of claims submitted during the policy period.
✅ Auto and General Gap Cover covers various medical procedures and treatments.
✅ Members can choose from three plans to suit their needs and budget.
✅ The policy covers pre-existing medical conditions after a 6-month waiting period.
✅ Policyholders have access to a 24/7 medical emergency helpline.
✅ Auto and General Gap Cover is underwritten by a reputable insurance company.

Furthermore, members can enjoy the convenience of an online claims submission process.

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Auto & General Gap Cover Features

Auto & General Essential Gap Cover

🟥 In-hospital Shortfalls	Covers procedure claim shortfalls up to 300% of medical scheme tariff.
🟧 Prescribed Minimum Benefits	All medical schemes must cover an emergency, 270, and 27 chronic conditions. Medical aid review is required.
🟨 Emergency Medical Treatment in a Casualty Unit	A&E will pay for emergency room or casualty unit treatment up to the specified amount if you are in an accident. Limited to R8,200 per policy annually.
🟩 Dental Treatment Benefit	After your medical aid processes your account, A&E will cover the shortfall for authorized in-hospital or doctor's office dental procedures paid from the in-hospital or major medical benefit only. Unlimited cover is provided but with a per-insured-person annual limit.
🟦 Oncology Gap Benefit	A&E will cover the difference between the service provider and medical scheme payment. Unlimited cover but subject to a per-insured-person annual limit.
🟪 Policy Extender	A&E pays the full gap cover premium If the policyholder dies accidentally. Limited to 12 months.

Auto & General Comprehensive Gap Cover

🟥 In-hospital Shortfalls	Covers procedure claim shortfalls up to 500% of medical scheme tariff.
🟧 Prescribed Minimum Benefits	All medical schemes must cover emergency, 270, and 27 chronic conditions. Medical aid review is required.
🟨 Emergency Medical Treatment in a Casualty Unit	A&E will pay for emergency room or casualty unit treatment up to the specified amount if you are in an accident. Limited to R16,500 per policy annually.
🟩 In Network Hospital Co-payments	A&E will pay your medical aid co-payment/deductible for certain in-hospital and doctor-performed procedures. Limited to R60,000 per policy per year
🟦 Co-payment Benefit – Out-of-hospital MRI, CT, and PET scans	The co-payment or deductible of your medical aid charges for MRI/CT/PET scans that have been authorized and paid from the in-hospital or Major Medical benefit. Limited to one annual MRI/CT/PET scan per policy up to R12,000.
🟪 Sub-limit Benefit – Internal Prostheses	A&E will cover the shortfall up to R20,000 per policy per year if you reach your medical aid's sub-limit for Internal Prostheses authorized and paid for from your In-Hospital or Major Medical benefit.
🟥 Dental Treatment Benefit	After your medical aid processes your account, A&E will cover the shortfall for authorized in-hospital or doctor's office dental procedures paid from the in-hospital or major medical benefit only. Unlimited cover is provided, but with a per-insured-person annual limit.
🟧 Global Fee Benefit	A&E will cover any service provider overcharges for a specific procedure like robotic surgery. Limited to R12,000 per policy annually.
🟨 Oncology Gap Benefit	A&E will cover the difference between the service provider and medical scheme payment. Unlimited, but with a per-insured-person annual limit.
🟩 Oncology “New Tech” Benefit	Keytruda®, Xalkori®, Tagrisso®, Yervoy®, Zelboraf®, Imbruvica® will be covered by A&E. Limited to R8,200 per policy annually.
🟦 Enhanced Cancer Cover – Lump Sum Pay-out	A&E will pay a lump sum if your oncologist or pathologist confirms "Stage 2" or higher cancer. First cancer diagnosis pay-out of R20,000.
🟪 Policy Extender	A&E will cover the gap cover premium if the main policyholder dies accidentally. Limited to 12 months.
🟥 Medical Aid Contribution Waiver	A&E will cover a policyholder's medical aid contribution for 6 months after the main policyholder's accidental death. Limited to R5,500 monthly.

Auto & General Absolute Gap Cover

🟥 In-hospital Shortfalls	Covers procedure claim shortfalls up to 700% of medical scheme tariff.
🟧 Prescribed Minimum Benefits	All medical schemes must cover emergency, 270, and 27 chronic conditions. Medical aid review is required.
🟨 Emergency Medical Treatment in a Casualty Unit	A&E will pay for emergency room or casualty unit treatment up to the specified amount if you are in an accident. Limited to R22,000 per policy annually.
🟩 In Network Hospital Co-payments	A&E will pay your medical aid co-payment/deductible for certain in-hospital and doctor-performed procedures. Unlimited, but with a per-insured-person annual limit.
🟦 Out of Network Hospital Co-Payments	Limited to 2 co-payments/deductibles per policy per year. Limited to R16,000.
🟪 Co-payment Benefit – Out-of-hospital MRI, CT, and PET scans	The co-payment or deductible of your medical aid charges for MRI/CT/PET scans that have been authorized and paid from the in-hospital or Major Medical benefit. Limited to two policy scans per year. Unlimited but subject to the annual aggregate limit per insured person.
🟥 Sub-limit Benefit – Internal Prostheses	A&E will cover the shortfall up to R40,000 per policy per year if you reach your medical aid's sub-limit for Internal Prostheses authorized and paid for from your In-Hospital or Major Medical benefit.
🟧 Sub-limit benefit – MRI, CT, and PET scans	Limited to 2 MRI/CT/PET scans per policy per year up to R5,000 per scan.
🟨 Dental Treatment Benefit	After your medical aid processes your account, A&E will cover the shortfall for authorized in-hospital or doctor's office dental procedures paid from the in-hospital or major medical benefit only. The unlimited cover is provided but with a per-insured-person annual limit.
🟩 Global Fee Benefit	A&E will cover any service provider overcharges for a specific procedure like robotic surgery. Limited to R24,000 per policy annually.
🟦 Oncology Gap Benefit	A&E will cover the difference between the service provider and medical scheme payment. Unlimited, but with a per-insured-person annual limit.
🟪 In-network Oncology Co-payment	Unlimited with a per-insured-person annual limit. Limited to R40,000 per event
🟥 Out-of-network Oncology Co-payment	Limited to 2 annual co-payments per policy up to R16,000.
🟧 Oncology Extender Benefit	Unlimited, but with a per-insured-person annual limit.
🟨 Oncology “New Tech” Benefit	Keytruda®, Xalkori®, Tagrisso®, Yervoy®, Zelboraf®, Imbruvica® will be covered by A&E. Limited to R16,500 per policy annually.
🟩 Policy Extender	A&E will cover the gap cover premium if the main policyholder dies accidentally. Limited to 12 months.
🟦 Medical Aid Contribution Waiver	A&E will cover a policyholder's medical aid contribution for 6 months after the main policyholder's accidental death. Limited to R6,600 monthly.

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How to apply for Gap Cover with Auto & General

💙To apply for Gap Cover with Auto & General, you can follow these steps:

✅ Visit the Auto & General website.
✅ Click the "Get a Quote" button to generate a quote based on your specific needs and budget.
✅ Complete the online application form with your personal and medical details.
✅ Review the policy details, terms, and conditions, and select the plan that best suits your requirements.
✅ Submit your application and pay the premium online or by bank transfer.
✅ Once your application has been processed and approved, you will receive a policy document and membership certificate via email.

You can then access your Gap Cover policy's benefits in case of a medical expense shortfall during hospitalization. Auto and General Gap Cover

How can I change my Auto & General Gap Cover option?

💙To change your Auto & General Gap Cover option, you can follow these steps:

Contact the Auto & General customer service team by calling their toll-free number or emailing them.
Explain that you would like to change your Gap Cover option and provide them with your policy number and personal details.
The customer service representative will guide you through the options and help you select a plan that suits your needs and budget better.
Once you have selected a new plan, the representative will make the necessary changes to your policy and advise you of any premium adjustments that may be required.
You will receive a confirmation of the changes made to your policy via email or post, along with an updated policy document and membership certificate if applicable.

Reviewing the new policy details, terms, and conditions and ensuring that the changes made accurately reflect your requirements is important.

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How can I change my Auto & General Gap Cover option

How to Submit a Claim for Gap Cover with Auto & General

💙To submit a claim for Gap Cover with Auto & General, you can follow these steps:

✅ Obtain the necessary claim forms from the Auto & General website or by contacting their customer service team.
✅ Complete the claim form with accurate information, ensuring all required fields are filled out.
✅ Include all supporting documentation, such as hospital admission/discharge records, medical invoices and receipts, and other relevant documents related to your claim.
✅ Submit the claim form and supporting documentation to Auto & General by emailing it.
✅ Auto & General will review your claim and may request additional information or documentation if required.
✅ Once your claim has been assessed and approved, you will receive a payment for the eligible amount of the medical expense shortfall.
✅ If your claim is rejected, you will be notified of the reason for the rejection and can appeal the decision or request a review of the claim.

It is important to keep a copy of all claim forms and supporting documentation for your records and to familiarise yourself with the terms and conditions of your policy to ensure that your claims are eligible for reimbursement. How to Submit a Claim for Gap Cover with Auto & General

How to Submit a Claim for Gap Cover with Auto & General

Auto & General Gap Cover Waiting Periods

💙The following is a summary of the waiting periods for Gap Cover policies:

✅ General waiting period: Gap Cover policies have no general waiting period.
✅ Condition-specific waiting period: A 10-month waiting period applies to the following conditions from the date of joining:
✅ Head, neck, and spinal procedures (including stimulators)
✅ All types of hernia procedures
✅ Endoscopic procedures (e.g., colonoscopy, gastroscopy)
✅ Pregnancy and childbirth (including cesarean delivery)
✅ Gynecological conditions (e.g., hysterectomy)
✅ Joint replacement (excluding treatment due to accidental trauma)
✅ Inability to walk/move without pain
✅ Any renal, kidney, and bladder conditions
✅ Cardiac (relating to the heart)
✅ Dentistry (unless due to accidental trauma or oncology)
✅ Cataracts or eye laser surgery (including all eye and lens procedures)

and many more. A full list of waiting periods will be provided by Auto & General. All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.

Cancer Diagnosis Waiting Period

💙The following relates to the Cancer diagnosis waiting period:

✅ If a policyholder is diagnosed with cancer before membership, all related claims will be subject to a nine (9) month waiting period.

If a policyholder has previously been diagnosed with cancer and is currently in remission, the policyholder needs to advise the insurer through medical evidence that the remission period has been for two (2) or more consecutive years.

Pre-existing Medical Conditions Waiting Period

💙The following is the pre-existing medical condition/s waiting period:

✅ No claims relating to any pre-existing condition/s that may lead to hospitalization (excluding cancer) will be covered within the first six (6) months of membership.
✅ The insurer reserves the right to request any clinical information from a policyholder’s doctor should a claim indicate or relate to a pre-existing condition in this period.

All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions. Auto & General Gap Cover Waiting Periods

Auto & General Gap Cover Waiting Periods

Auto & General Gap Cover vs Other Notable Providers

🔎 Gap Cover Provider	🥇 Auto & General	🥈 Sanlam	🥉 Liberty
🟥 Underwriters	1Life Insurance Limited	Centriq Insurance Company Limited	Guardrisk Life Limited (FSP 76)
🟧 Number of Plans	3	1	2
🟨 Average Price	R99	R320	R253
🟩 Waiting Periods	10 months	3 – 12 months	12 Months
🟦 Exclusions	✅ Yes	✅ Yes	✅ Yes
🟪 Oncology Benefit	✅ Yes	✅ Yes	✅ Yes
🟥 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟧 Out-of-Hospital Cover	✅ Yes	✅ Yes	✅ Yes
🟨 Maternity Benefit	None	None	✅ Yes
🟩 Scopes and Scans	✅ Yes	None	✅ Yes
🟦 Co-payment Cover	✅ Yes	✅ Yes	✅ Yes
🟪 Emergency Room	✅ Yes	✅ Yes	✅ Yes
🟥 Accidental Cover	✅ Yes	✅ Yes	✅ Yes
🟧 Trauma Counseling	✅ Yes	None	✅ Yes
🟨 Premium Waiver	✅ Yes	✅ Yes	✅ Yes
🟩 Non-DSP Co-Payment	None	✅ Yes	✅ Yes
🟦 Prostheses	✅ Yes	None	✅ Yes
🟪 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	None
🟥 Travel Cover Extender	None	None	✅ Yes

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Auto & General Gap Cover vs Other Notable Providers

Auto & General Gap Cover Pros and Cons

✅ Pros	❌ Cons
Protection against medical expense shortfalls during hospitalization	Waiting periods for pre-existing medical conditions
Unlimited cover for in-hospital specialist fees, with a 700% reimbursement of medical aid rates	Some medical procedures and treatments may not be covered
Cover for co-payments, deductibles, and other out-of-pocket expenses	Premiums may be relatively high, depending on the plan
No overall limit on the number of claims that can be submitted during the policy period	Claims may be subject to review to identify pre-existing conditions

Our Verdict on Auto & General Gap Cover

A&E provides various products, including health insurance, gap cover, and life insurance. The insurer is well-established in the South African market. Furthermore, A&E has a reputation for providing high-quality service to its customers. One of the stand-out features of A&E is its commitment to providing excellent customer support. Customers have reported positive experiences with A&E's customer service team, noting that they are friendly, professional, and responsive. A&E also offers a range of convenient channels for customers to get in touch, including a call center, email, and social media platforms.

Auto & General Gap Cover Frequently Asked Questions

Can I choose the level of cover I want with the Auto and General gap cover?

Yes, Auto and General offer three different plans for gap cover, allowing you to choose the level of cover that best suits your needs and budget.

Does Auto and General Gap cover have waiting periods?

Yes, Auto and General gap cover policies have waiting periods for pre-existing medical conditions and some medical procedures and treatments.

Are pre-existing medical conditions covered by Auto and General gap cover?

Yes, Auto and General gap cover policies cover pre-existing medical conditions after a 6-month waiting period.

What is the process for submitting a claim for Auto and General gap cover?

You can submit a claim for Auto and General gap cover by completing a claim form and providing supporting documentation. The claim can be submitted online, by email, fax, or post.

Is there a limit on the number of claims I can submit during the policy period?

No, there is no overall limit on the number of claims submitted during the policy period.

What types of medical procedures and treatments are covered by Auto and General gap cover?

Auto and General Gap Cover covers a wide range of medical procedures and treatments, including chemotherapy and radiotherapy for cancer treatment, MRIs and CT scans, and emergency medical treatment.

How is the reimbursement rate determined for in-hospital specialist fees with Auto and General gap cover?

Auto and General gap cover provides unlimited cover for in-hospital specialist fees, with a 700% reimbursement of medical aid rates.

What are the premiums for the Auto and General gap cover?

Premiums for Auto and General gap cover depend on the level of cover selected and other factors such as age and medical history. However, Auto and General’s gap cover starts from R99.

Auto & General Gap Cover and Plans