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Dis-Chem Health Medical Aid Gap Cover (🇿🇦 2026)

Overall, Dis-Chem Day-to-day Medical Aid and Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Dis-Chem Gap Cover Plans start from R26 ZAR for a Child. Dis-Chem Gap Cover has a trust score of 4.1.

Dis-Chem Gap Cover has two plans to choose from:

- Dis-Chem Gap Summit
- Dis-Chem Gap Base

🟥 Date Established	1978 (Dis-Chem)
🟧 Underwriters	Old Mutual Insure
🟨 Headquartered	Midrand, Gauteng
🟩 The average number of members	5,000+
🟦 Number of Markets	1
🟪 Market Share	<1%
🟥 The number of plans offered	2
🟧 Is a Mobile App offered	✅ Yes
🟨 Customer Support Operating Hours	Monday to Friday – 8 am to 5 pm
🟩 Waiting Period	3 – 12 months
🟦 Exclusions	✅ Yes

Dis-Chem Medical Aid Gap Cover – 12 Key Point Quick Overview

Dis-Chem Medical Gap Cover Premiums

Dis-Chem Base Premiums

🟥 Age Bracket	🟧 Main Member	🟨 Adult Premiums	🟩 Child Premiums
🟧 <18	N/A	N/A	R26
🟨 18 – 39	R164	R90	R37 for children up to 26
🟩 40 – 49	R206	R112	N/A
🟦 50 – 59	R270	R148	N/A
🟪 60>	R331	R212	N/A

Dis-Chem Summit Premiums

🟥 Age Bracket	🟧 Main Member	🟨 Adult Premiums	🟩 Child Premiums
🟧 <18	N/A	N/A	R43
🟨 18 – 39	R245	R137	R57 for children up to 26
🟩 40 – 49	R279	R159	N/A
🟦 50 – 59	R333	R198	N/A
🟪 60>	R456	R304	N/A

👉🏾 READ more about the 5 Best Gap Cover Options for Under R200

Dis-Chem Gap Cover for medical aid – Advantages over Competitors

Choosing Dis-Chem Gap Cover comes with a long list of advantages, including:

✅ Dis-Chem Gap Cover covers medical expenses not covered by medical aids, such as co-payments, deductibles, and shortfalls.
✅ The cover is available for both in-hospital and out-of-hospital medical procedures.
✅ Members can choose from three plans to suit their specific needs and budgets.
✅ The cover includes emergency medical transportation, which can be costly without insurance.
✅ Dis-Chem Gap Cover provides an additional benefit of up to R50,000 in the event of accidental death or permanent disability.
✅ Members have access to a 24/7 emergency medical helpline, which can aid in the case of medical emergencies.
✅ The cover is available to individuals and families, with no age limit on joining.
✅ The claims process is straightforward and hassle-free, with claims paid directly to the service provider in most cases.
✅ Old Mutual Insure, a trusted and reputable insurance provider, underwrites Dis-Chem Gap Cover.

The cover can be purchased online, making it convenient and accessible.

👉🏾 You might consider reading more about Dis-Chem health insurance plan and prices

Dis-Chem Gap Cover Features

Dis-Chem Gap Base Cover Benefits

🟥 Overall Annual Limit	There is an overall annual limit of R198,660 per insured per year.
🟧 Tariff Shortfalls	Subject to the overall annual limit of R198,660 per insured per year.
🟨 Shortfalls from Sub-limits	Limited to R32,500.
🟩 Out-of-Hospital Tariff Shortfalls	Limited to an additional 500% of the medical scheme tariff.
🟦 Dental Reconstruction Benefit	Limited to two events per family per year. Limited to R45,700 per year.

Dis-Chem Gap Base Benefit Extenders

🟥 Hospital Booster	Day 1 to 13 – R412 per day. Day 14 – 20 – R803 per day. Day 21 – Day 30 – R1,555 per day. Maximum benefit of R28,500 per insured per year.
🟧 Family Protector	Limited to R20,000 for children <6 years. Limited to R28,000 for all other insured persons.
🟨 Medical Scheme Contribution Waiver	Contributions will be covered for six months, up to R35,500. This benefit is only available once during the policy’s lifetime.
🟩 Gap Cover Premium Waiver	The Dis-Chem Health Gap Cover premium will be waived six months after the event. This benefit is only available once during the policy’s lifetime.
🟦 Road Accident Fund Claims	Covered by the policy.

Dis-Chem Gap Summit Cover Benefits

🟥 Overall Annual Limit	There is an overall annual limit of R198,660 per insured per year.
🟧 Tariff Shortfalls	Subject to the overall annual limit of R198,660 per insured per year.
🟨 Co-Payments and Deductibles	Covers diagnostic and medical procedure cover during hospitalization.
🟩 Shortfalls from Sub-limits	Limited to R64,500.
🟦 Oncology Tariff Shortfalls	The Oncology Shortfall Benefit provides additional cover of up to 500% of the Medical Scheme rate to cover oncology treatment shortfalls.
🟪 Oncology Sub-Limits	Benefits are payable for oncology and related Treatment approved by the Insured Party’s Medical Scheme for treating cancer (malignant neoplasm) during an Insured Event. The Benefit payable is equal to the charged amount less the amount paid by the Medical Scheme of the Insured Party.
🟥 Oncology Co-Payments	The Oncology Co-payment Benefit pays the 20% Oncology-Related Co-Payment imposed by the Medical Scheme.
🟧 Out-of-Hospital Tariff Shortfalls	Limited to an additional 500% of the medical scheme tariff.
🟨 Penalty Co-payment	Limited to per Family per year, with a maximum of R18,550 per event. Cover for penalty Co-payments or Deductibles that do not exceed 30% for the voluntary use of a non-Network Hospital by an Insured Party.
🟩 Innovative Oncology Medicines	As it relates to Innovative Oncology Medicines, a value equal to the lesser of 25% of the total drug cost, or R13,780, is covered. Cover for shortfalls in Innovative Oncology Medicines as defined by the Medical Scheme of the Insured Party.
🟦 Dental Reconstruction Benefit	Limited to two events per family per year. Limited to R49,900 per year.

Dis-Chem Gap Summit Benefit Extenders

🟥 Family Booster	Limited to R15,900.
🟧 Child Casualty Illness	Subject to 2 events per year and R2,860 per event.
🟨 Accidental Casualty	Limited to R18,450 per event.
🟩 Hospital Booster	Day 1 to 13 – R480 per day. Day 14 – 20 – R860 per day. Day 21 – Day 30 – R1,700 per day. Maximum benefit of R29,300 per insured per year.
🟦 Family Protector	Limited to R20,000 for children <6 years. Limited to R30,000 for all other insured persons.
🟪 Medical Scheme Contribution Waiver	Contributions will be covered for six months, up to R35,500. This benefit is only available once during the policy’s lifetime.
🟥 Gap Cover Premium Waiver	The Dis-Chem Health Gap Cover premium will be waived six months after the event. This benefit is only available once during the policy’s lifetime.
🟧 Road Accident Fund Claims	Covered by the policy.

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How to apply for Gap Cover with Dis-Chem Medical Aid

To apply for Gap Cover with Dis-Chem Medical Aid – Medical Products, you can follow these steps:

✅ Visit the Dis-Chem website at www.dischem.co.za and navigate to the Gap Cover page.
✅ Choose the plan that best suits your needs and budget, and click the “Apply Now” button.
✅ Complete the application form with your details, including your name, contact information, and medical aid details.
✅ Review the terms and conditions of the cover and ensure you understand the benefits and limitations.
✅ Submit the application form and wait for approval from Dis-Chem.
✅ Once your application is approved, you will receive a confirmation email with your policy documents and details on making payments.

Your cover will become effective once your first premium payment is received.

How can I change my Dis-Chem Gap Cover option?

You can easily switch from your current Gap cover to Dis-Chem Health Gap. However, it would help if you did not allow a break in your cover to ensure that the waiting periods are applied fairly.

If you are a Dis-Chem Gap Cover member and would like to change your plan option, you can follow these steps:

✅ Contact the Dis-Chem Gap Cover call center on 0860 10 53 40 and inform the consultant that you want to change your plan option.
✅ The consultant will guide you through the process and explain the options available.
✅ Once you choose a new plan option, the consultant will provide the necessary forms and documentation to complete the process.
✅ Complete the forms and return them to Dis-Chem and any other required documentation.
✅ Your new plan option will become effective from the start of the next calendar month.

If the coverage gap is less than 90 days, the unexpired portion of the waiting periods from the previous policy will be transferred to your Dis-Chem Health Gap policy, and if you have already completed your waiting periods on your previous Gap cover, no waiting periods will apply on Dis-Chem Health Gap.

How to Submit a Claim for Gap Cover with Dis-Chem Medical Aid

To submit a claim for Gap Cover with Dis-Chem, you can follow these steps:

✅ Obtain the necessary claim forms from the Dis-Chem Gap Cover website or call center.
✅ Complete the claim form fully, ensuring all required information is provided.
✅ Attach all relevant documentation to support your claims, such as invoices, statements, and medical reports.
✅ Submit the claim form and supporting documentation to Dis-Chem Gap Cover via email, fax, or post. The contact details for submission can be found on the claim form or the Dis-Chem website.
✅ Dis-Chem Gap Cover will process your claim and may request additional information or documentation if required.

Once your claim has been processed, Dis-Chem Gap Cover will inform you of the outcome and any payment due.

Dis-Chem Gap Cover Exclusions

The following are exclusions to Dis-Chem Administrators Gap Cover claims:

✅ The insured’s medical aid will not cover claims excluded or rejected.
✅ Claims not included in the registered benefits of the insured’s medical aid but paid on an ex-gratia basis will not be covered.
✅ Any fee charged by a medical practitioner, hospital, or healthcare provider that constitutes split billing as defined in the policy will not be covered except for balance billing.
✅ Treatment or medical procedures for infertility outside the period of cover and external prosthesis will not be covered.
✅ Appliances, including wheelchairs, beds, or convalescing equipment, specialized dental procedures, harvesting or preserving of human tissues, and breast augmentation are excluded.

Gender reversal procedures, gastroplasty, lipectomy, otoplasty, therapeutic massage therapists, rehabilitation, frail care, hospice services, step-down facilities, and TTO medicines are excluded.

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Dis-Chem Gap Cover Waiting Periods

The following are the Dis-Chem Health Gap waiting periods:

✅ 12-month Condition-Specific Waiting Period – You cannot claim benefits for a condition for which medical advice, diagnosis, care, or treatment was recommended or received within the 12 months preceding the Inception Date of your cover.

A newborn or Spouse will not be subject to waiting periods if they are added to your policy within 90 days of birth or marriage date.

Dis-Chem Gap Cover vs Other Notable Providers

🔎 Gap Cover Provider	🥇 Dis-Chem (2026)	🥈 Auto & General	🥉 Turnberry
🟥 Underwriters	Kaelo Risk (Pty) Ltd	1Life Insurance Limited	Lombard Insurance Company
🟧 Number of Plans	2	3	5
🟨 Starting Price	R164 – R456	R99	R164
🟩 Waiting Periods	3 – 12 months	3 – 12 months	3 – 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	None
🟩 Scopes and Scans	✅ Yes	✅ Yes	✅ Yes
🟦 Co-payment Cover	✅ Yes	✅ Yes	✅ Yes
🟪 Emergency Room	✅ Yes	✅ Yes	✅ Yes
🟥 Accidental Cover	✅ Yes	✅ Yes	✅ Yes
🟧 Trauma Counseling	✅ Yes	✅ Yes	✅ Yes
🟨 Premium Waiver	✅ Yes	✅ Yes	✅ Yes
🟩 Non-DSP Co-Payment	✅ Yes	None	✅ Yes
🟦 Prostheses	✅ Yes	✅ Yes	✅ Yes
🟪 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	✅ Yes
🟥 Travel Cover Extender	✅ Yes	None	None

Dis-Chem Gap Cover Pros and Cons

✅ Pros	❎ Cons
Covers medical expenses that are not fully covered by medical aids	Exclusions and waiting periods may apply
Access to emergency medical transportation	Some medical procedures may not be covered
Accidental death and disability cover	Limited choice of plan options

Our Verdict on Dis-Chem Medical Aid Gap Cover

Dis-Chem Gap Cover offers individuals and families a valuable form of insurance to cover medical expenses not fully covered by medical aids, such as co-payments, deductibles, and shortfalls.

Members can access various benefits, including emergency medical transportation, accidental death and disability cover, and a 24/7 medical helpline. With a choice of three plan options and a straightforward claims process, Dis-Chem Gap Cover is a convenient and accessible way to protect against the high costs of medical care.

Overall, Dis-Chem Gap Cover is a reliable and reputable insurance product that provides its members peace of mind and financial protection.

Dis-Chem Gap Cover Frequently Asked Questions

What is Dis-Chem Gap Cover?

Dis-Chem Gap Cover is a form of insurance covering medical expenses not fully covered by medical aids, such as co-payments, shortfalls, and deductibles.

What does Dis-Chem Gap Cover include?

Dis-Chem Gap Cover includes in-hospital and out-of-hospital cover, emergency medical transportation, accidental death and disability cover, and a 24/7 medical helpline.

How many plan options are available with Dis-Chem Gap Cover?

Dis-Chem Gap Cover offers two plan options to choose from.

Are there waiting periods or exclusions with the Dis-Chem Gap Cover?

Yes, waiting periods or exclusions may apply to certain medical procedures or conditions.

How do I claim with Dis-Chem Gap Cover?

To claim with Dis-Chem Gap Cover, you must complete a claim form and submit it, along with supporting documentation, to Dis-Chem Medical Aid via email, fax, or post.

How long does it take for a claim to be processed with a Dis-Chem Gap Cover?

The processing time for a claim with a Dis-Chem Gap Cover may vary but typically takes a few days to a few weeks depending on the complexity of the claim.

What are the premiums for Dis-Chem Gap Cover?

The premiums for Dis-Chem Gap Cover may vary depending on the plan option chosen and the individual’s specific circumstances. Premiums with Dis-Chem typically start from R23 per month.

Can I change my plan option with Dis-Chem Gap Cover?

Yes, you can change your plan option with Dis-Chem Gap Cover. Contact the Dis-Chem Gap Cover call center for assistance with changing your plan option.

Does Dis-Chem Gap Cover cover pre-existing medical conditions?

No, Dis-Chem Gap Cover does not cover pre-existing medical conditions.

How do I apply for Dis-Chem Gap Cover?

You can apply for Dis-Chem Gap Cover online via the Dis-Chem website or by visiting your nearest Dis-Chem pharmacy and speaking to a consultant.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.