Essential Gap
About this plan
An affordable entry-level option covering specialist shortfalls during authorised hospital procedures, PMBs, casualty treatment, and selected dental benefits. Suitable for younger, healthy members wanting basic protection.
Monthly premium
From
R99
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Essential Gap
Auto & General Essential Gap (🇿🇦 2025)
Overall, Auto & General Essential Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those with medical aid. The Auto & General Essential Gap Cover Plan starts from R99 ZAR. Auto & General has a trust score of 4.1.| 🟥 Provider | 🥇 Auto & General Essential Gap Cover |
| 🟧 Years in Operation | 38 years |
| 🟨 Underwriters | 1Life Insurance Limited |
| 🟩 Market Share in South Africa | <5% |
| 🟦 Gap Cover Waiting Period | 10 months |
| 🟪 Do Exclusions Apply | ✅ Yes |
| 🟥 Average Monthly Premium | R99 |
| 🟧 Oncology Benefit | ✅ Yes |
| 🟨 In-Hospital Benefit | ✅ Yes |
| 🟩 Out-of-Hospital Cover | ✅ Yes |
Auto & General Essential Gap Cover - 7 Key Point Quick Overview
- ✅ Auto & General Essential Gap Overview
- ✅ Auto & General Essential Gap Premiums
- ✅ Auto & General Essential Gap Benefits and Cover Breakdown
- ✅ Auto & General Essential Gap Exclusions and Waiting Periods
- ✅ Auto & General Essential Gap vs Other Gap Cover Plans
- ✅ Our Verdict on Auto & General Essential Gap
- ✅ Auto & General Essential Gap Frequently Asked Questions
Auto & General Essential Gap Overview
The Auto & General Essential Gap is one of three plans that starts from R99 per month. Auto & General’s Essential Gap has benefits for oncology, policy extenders, dental treatment, in-hospital shortfalls, PMBs, and more. Auto & General Gap Cover has three plans to choose from:
Auto & General Essential Gap Premiums
| 🟥 Under 65 (based on the oldest beneficiary) premium per policy monthly | N/A |
| 🟧 Premium per individual per policy monthly | R99 |
| 🟨 Premium per family per policy monthly | R180 |
| 🟩 Over 65’s (based on the oldest beneficiary) premium per policy monthly | R360 |
Auto & General Essential Gap Benefits and Cover Breakdown
| 🟥 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. The 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. |
💙Poll: 5 Best Medical Aids Covering Spectacles & Optometry
Auto & General Essential Gap Exclusions and Waiting Periods
Auto & General Essential Exclusions
Auto & General does not include its specific exclusions on its policy document. However, below we provide some typical exclusions that might relate to gap cover:- ✅ Pre-existing conditions: Conditions known or diagnosed before the policy start date.
- ✅ Waiting periods: Certain services might not be covered until a specific period has passed.
- ✅ Specific procedures or treatments: Certain medical procedures or treatments might be excluded.
- ✅ Age limits: Cover might cease after reaching a certain age.
- ✅ Non-disclosure or misrepresentation: Failure to disclose relevant information or misrepresenting health status could lead to claim denial.
- ✅ Specific illnesses or injuries: Illnesses or injuries related to certain factors like alcohol or drug use might be excluded.
Auto & General Essential Waiting Periods
💙There is no general three-month waiting period when you register a Gap Cover policy. A 10-month condition-specific waiting period applies. No claims may be submitted within the first 10 months of membership for any Gap Cover policy if they relate to any of the following conditions:- ✅ Head, neck, and spinal procedures
- ✅ All types of hernia procedures
- ✅ Endoscopic procedures, e.g., Colonoscopy, Gastroscopy
- ✅ Pregnancy and childbirth
- ✅ Gynecological conditions
- ✅ Joint replacement
- ✅ Carpal Tunnel Syndrome
- ✅ Any Ear, Nose, and Throat procedures
- ✅ Diabetes and related complications
- ✅ Respiratory conditions, e.g., COPD; Cystic Fibrosis
💙Read more about the 5 Best Medical Aids for Bambino - also known as a Tot in South Africa
Auto & General Essential Gap vs Other Gap Cover Plans
| 🟥 Provider | 🥇 Auto & General Essential Gap Cover | 🥈 Dis-Chem Gap Base | 🥉 Liberty Essential Gap Cover |
| 🟧 Years in Operation | 38 years | 36 years | 66 years |
| 🟨 Underwriters | 1Life Insurance Limited | Old Mutual Insure | Guardrisk Life Limited (FSP 76) |
| 🟩 Market Share in South Africa | <5% | <1% | >25% |
| 🟦 Gap Cover Waiting Period | 10 months | 3 – 12 months | 12 months |
| 🟪 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟥 Average Monthly Premium | R99 | R152 | R397 |
| 🟧 Oncology Benefit | ✅ Yes | None | None |
| 🟨 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟩 Out-of-Hospital Cover | ✅ Yes | ✅ Yes | None |
| 🟦 Maternity Benefit | None | None | None |
| 🟪 Scopes and Scans | None | None | ✅ Yes |
| 🟥 Co-payment Cover | None | None | None |
| 🟧 Emergency Room | ✅ Yes | None | ✅ Yes |
| 🟨 Accidental Cover | None | ✅ Yes | ✅ Yes |
| 🟩 Trauma Counseling | None | None | ✅ Yes |
| 🟦 Premium Waiver | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Non-DSP Co-Payment | None | None | None |
| 🟥 Prostheses | None | None | None |
| 🟧 Travel Cover Extender | None | None | None |
| 🟨 Accidental Death/ Permanent Disability | None | ✅ Yes | ✅ Yes |
