Discovery Health Gap Cover (🇿🇦 2025)

Overall, Discovery Health Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those with medical aid. Discovery Health Gap Cover starts from R157 ZAR. Discovery Health Gap Cover has a trust score of 4.4.

 

Discovery Health Gap Cover has three Gap cover options:

✅ Discovery Health Gap Core

✅ Discovery Health Gap Comprehensive

✅ Discovery Gap Active

 

🟥 Underwriters	Discovery Insure Ltd
🟧 Number of Markets	40
🟨 Market Share	>56%
🟩 The number of plans offered	2
🟦 Mobile App	✅ Yes
🟪 Waiting Period	Up to 12 months
🟥 Exclusions	✅ Yes

 

 

Discovery Health Gap Cover – 16 Key Point Quick Overview

1. ✅ Discovery Health Gap Cover Premiums
2. ✅ Discovery Health Gap Cover – Advantages over Competitors
3. ✅ Discovery Health In-Hospital Specialist Gap Cover
4. ✅ Discovery Health Hospital Admission Benefit Extender
5. ✅ Discovery Health Additional Benefit Extenders
6. ✅ Discovery Gap Cover Plans
7. ✅ Discovery Vitality Health Benefit Extenders for Annual Hospital Admission
8. ✅ How to apply for Gap Cover with Discovery Health
9. ✅ How can I change my Discovery Health Gap Cover option?
10. ✅ How to Submit a Claim for Gap Cover with Discovery Health
11. ✅ Discovery Health Gap Cover Exclusions and Waiting Periods
12. ✅ Discovery Health Gap Cover vs. Other Notable Providers
13. ✅ Discovery Health Gap Cover Pros and Cons
14. ✅ Discovery Health User Reviews
15. ✅ Our Verdict on Discovery Health Gap Cover
16. ✅ Discovery Health Gap Cover Frequently Asked Questions

 

Discovery Health Gap Cover Premiums

 

Discovery Gap Core

🔎 Discovery Gap Core	🅰️ Discovery Executive and Classic Plans	🅰️ Discovery Executive and Classic Plans	🅱️ Discovery Essential Plans	🅱️ Discovery Essential Plans	🅾️ Discovery Coastal Plans	🅾️ Discovery Coastal Plans
🔍 Age of oldest member on the plan	❤️ Single Member	💙 Family	❤️ Single Member	💙 Family	❤️ Single Member	💙 Family
🟥 0 – 54	R157	R271	R291	R525	R319	R749
🟧 55 – 64	R281	R335	R659	R1,089	R724	R1,089
🟨 65+	R326	R491	R988	R1,742	R1,086	R1,742

 

Discovery Gap Comprehensive

🔎 Discovery Gap Comprehensive	🅰️ Discovery Executive and Classic Plans	🅰️ Discovery Executive and Classic Plans	🅱️ Discovery Essential Plans	🅱️ Discovery Essential Plans	🅾️ Discovery Coastal Plans	🅾️ Discovery Coastal Plans
🔍 Age of oldest member on the plan	❤️ Single Member	🧡 Family	❤️ Single Member	🧡 Family	❤️ Single Member	🧡 Family
🟨 0 – 54	R248	R420	R426	R748	R468	R1,069
🟩 55 – 64	R420	R641	R780	R1,633	R857	R1,633
🟦 65+	R538	R889	R1,036	R2,147	R1,139	R2,147

 

Discovery Gap Active

🔎 Discovery Gap Comprehensive	🅰️ Discovery Executive and Classic Plans	🅰️ Discovery Executive and Classic Plans	🅱️ Discovery Essential and Active Smart Plans	🅱️ Discovery Essential and Active Smart Plans	🅾️ Discovery Coastal Plans	🅾️ Discovery Coastal Plans
🔍 Age of oldest member on the plan	❤️ Single Member	🧡 Family	❤️ Single Member	🧡 Family	❤️ Single Member	🧡 Family
🟨 0 – 54	R49	R140	R49	R200	R75	R300
🟩 55 – 64	R99	R175	R99	R300	R120	R400
🟦 65+	R267	R318	R400	R661	R688	R1,035

 

💙You might like to read more about Discovery Health Medical Aid Plans

 

 

Discovery Health Gap Cover for medical aid – Advantages over Competitors

 

💙Choosing Discovery Health Gap Cover comes with a long list of unique advantages. These advantages include:

• ✅ Covers Tariff Shortfalls. Discovery Health Gap Cover helps pay for the difference between your specialist’s charges and the amount covered by your medical scheme.
• ✅ High Cover Limits. Discovery Gap Comprehensive provides cover of up to 500% of the medical scheme rate. In comparison, Discovery Gap Core offers a cover of up to 250%.
• ✅ Flexible Account Types. Different account types are available to suit the needs of various users.
• ✅ Short Waiting Periods. With a general waiting period of only three months and the option to waive waiting periods, policyholders can quickly access coverage.
• ✅ Pre-existing Condition Exclusions Waived. Policyholders who have had gap cover with another insurance company for at least six months may have their pre-existing condition exclusion waived.
• ✅ Comprehensive Benefit Extenders. The policy includes Benefit Extenders, which provide funding for out-of-hospital claims.
• ✅ International Travel Benefits. Policyholders can receive funding for claims incurred outside the Republic of South Africa.
• ✅ Co-payments Covered. Discovery Gap Comprehensive covers co-payments and deductibles that qualify for funding as part of the Benefit Extenders.

 

Finally, the Annual Limit. The Discovery Gap Cover policy has an overall limit of R210,580 per person per year.

 

 

Discovery Health In-Hospital Specialist Gap Cover

 

💙 Discovery Health offers an In-hospital Specialist Gap Cover designed to address the tariff shortfalls that may occur when a patient is admitted to the hospital.  In such a scenario, the specialist’s charges may be higher than what is covered by the patient’s medical scheme. This gap coverage compensates for the approved in-hospital specialist claims.

 

💙 Furthermore, the cover extends to dental specialist claims funded by the hospital benefit provided by the medical scheme.

 

💙 The In-hospital Specialist Gap Cover provides cover of up to 500% of the medical scheme rate for those enrolled in the Discovery Gap Comprehensive plan and up to 250% for those enrolled in the Discovery Gap Core plan.

 

 

Discovery Health Hospital Admission Benefit Extender

💙 For any remaining shortfalls on approved specialist claims while in the hospital, the Comprehensive plan will cover up to R15,000, and the Core plan will cover up to R7,500.  The Hospital Admission Benefit Extender on Discovery Gap Comprehensive would cover the following additional healthcare services if your medical plan approved your hospital admission:

 

• ✅ Private Ward Cover – This covers the difference between the general ward fee covered by your medical plan and the private ward fee for hospital admissions that have been approved.
• ✅ This benefit is subject to a maximum of 5 days per person annually and will depend on available in-hospital.
• ✅ Medicine Prescribed upon discharge from the hospital – Covers shortfalls on your claims for medication to take home after discharge.
• ✅ This benefit is only available for those with plans with a Medical Savings Account.
• ✅ Out-of-Hospital Specialist Claims cover shortfalls on your admitting specialist’s claims that occur one month before hospital admission if you are accepting specialist charges more than the amount covered by your medical plan.
• ✅ This benefit is only available for those with plans with a Medical Savings Account.
• ✅ If your radiologist bills you more than your health insurance will cover in the month before you are admitted, don’t worry; Out-of-Hospital Radiology will cover the difference.
• ✅ This benefit is only available for those with plans with a Medical Savings Account.
• ✅ Third-trimester maternity Claims cover shortfalls when third-trimester maternity claims exceed the amount covered by your medical plan’s maternity benefit.
• ✅ If the member’s medical aid plan does not have an MSA, gap cover will only cover shortfalls on the third-trimester claims. Furthermore, these are paid from the Maternity Risk-Benefit of Discovery Health.
• ✅ Out-of-hospital rehabilitation covers shortfalls on claims for professional fees charged by certain allied healthcare professionals in the month following hospital discharge if allied healthcare professionals charge more than the amount covered by your medical scheme.
• ✅ This benefit is only available for those with plans with a Medical Savings Account.
• ✅ TytoHome Kit – The 25% deductible payable when purchasing a TytoHome Kit is covered on the Discovery Gap Comprehensive plan.

 

💙 This benefit is only available to women enrolled in the Discovery Health Medical Scheme’s maternity program who have the Executive, Comprehensive, Priority, Saver, or Smart plan.

 

 

Discovery Health Additional Benefit Extenders

 

Discovery Health Oncology Benefit Extender

💙 After registering for your scheme’s oncology benefit and reaching the oncology threshold, the Oncology Benefit Extender will assist you in covering co-payments for cancer-related expenses approved by your medical plan.

 

💙 Depending on the Discovery Gap Cover option, you will receive up to R100,000 to cover shortfalls on approved cancer-related claims once you have reached your scheme’s oncology threshold.

 

Discovery Health Travel Benefit Extender

💙 The Discovery Gap Comprehensive plan covers shortfalls on emergency medical claims incurred while traveling outside South Africa.

 

👉 Furthermore, your policy covers the following shortfalls for approved International Travel Benefit claims:

 

• ✅ The $150 / €100 deductible for out-of-hospital emergency claims
• ✅ Shortfalls on approved claims once you have reached your scheme’s travel limit of R5 million ($1 million for Executive plans) per person per trip.

 

💙 Deficiencies in the Cleveland MyClinic consultation fee for a second opinion.

 

Discovery Health Scopes and Scans Benefit Extender

💙 The hospital bill for pre-approved endoscopies (gastroscopy, sigmoidoscopy, proctoscopy, and colonoscopy) is all covered in the Discovery Gap Comprehensive plan. Furthermore, MRI and CT scans are performed outside of a hospital, with the remaining cost covered by the scheme.

 

👉 You might consider reading more about the Best Gap Cover with No Waiting Period

 

 

 

Discovery Gap Cover Plans

 

Discovery Gap Core

 

In-Hospital Specialist Gap Cover

• ✅ Covers expenses beyond what your medical insurance plan pays for up to 250% of the medical scheme rate.

 

Hospital Admission Benefit Extender

• ✅ Gap Core received up to R7,500 extra gap cover for shortfalls on approved specialist claims made in the hospital beyond what is covered by your In-hospital Specialist Gap Cover.

 

Benefit Extenders

• ✅ The Oncology Benefit Extender provides up to R75,000 additional cover per person per year.

 

Discovery Gap Comprehensive

 

In-Hospital Specialist Gap Cover

• ✅ Pays up to 500% of the medical scheme rate if you need extra coverage beyond what your medical scheme provides.

 

Hospital Admission Benefit Extender

• ✅ An additional R15,000 in gap cover is yours if you qualify for the following:
• ✅ Shortfalls on approved specialist claims made in the hospital beyond what your In-hospital Specialist Gap Cover covers.
• ✅ You will be responsible for non-hospital costs associated with your authorized hospital stay.
• ✅ Cover for a private hospital room if one is available in the event of pre-approved hospital admission.
• ✅ For a maximum of 5 nights per year, this plan will pay the difference between the general ward fee your health insurance will cover for authorized hospital admission and the private ward fee you will be charged.

 

Scopes and Scans

• ✅ Cover for endoscopies (gastroscopy, sigmoidoscopy, proctoscopy, and colonoscopy) on the hospital bill after the Scopes and Scans Benefit Extender provides authorized hospital admission.
• ✅ Offers reimbursement for the portion of the cost not covered by health insurance for MRI and CT scans performed outside of a hospital.

 

Travel

• ✅ Shortfalls on approved emergency medical claims outside of South Africa are covered, up to the policy maximum, minus the $150/€100 deductible for claims made outside of a hospital.
• ✅ Cleveland MyClinic’s second opinion consultation fee also covers the benefit’s limits.

 

Oncology

• ✅ Offers up to R100,000 annually per person to make up for gaps in cover for approved cancer-related claims after the oncology threshold of the participant’s health insurance plan has been reached.

 

Discovery Gap Active

 

In-Hospital Specialist Gap Cover

• ✅ In-Hospital Specialist Gap Cover acts as one of the main elements of Discovery Gap Active. Under this benefit your hospital specialist claims get full coverage which exceeds medical scheme rates of approval. Members who require out-of-pocket expenses because a specialist’s charges exceed the medical scheme’s reimbursement benefit from Gap Active’s coverage of the amount between these rates.

 

Hospital Admission Benefit Extender

• ✅ Among the essential elements of Gap Active stands the Hospital Admission Benefit Extender. The Hospital Admission Benefit Extender provides supplemental coverage of up to R7,500 annually to each policy which adjusts according to Discovery Vitality level and health plan categories along with household composition. The Hospital Admission Benefit Extender automatically fills in remaining costs which exceed payments made by medical schemes together with In-Hospital Specialist Gap Cover thus creating additional safety throughout hospital expenses.

 

Scopes and Scans

• ✅ Discovery Gap Active provides additional coverage to prevent financial gaps that might occur because of particular medical procedures. The plan covers endoscopy costs that arise as a result of hospital stays the company approves. The benefit for MRI and CT scans performed at hospital locations is only accessible through Gap Comprehensive whereas Gap Active does not provide coverage for this benefit.

 

Travel

• ✅ Gap Comprehensive offers a Travel Benefit Extender to compensate approved emergency medical costs when traveling abroad but Gap Active lacks this specific feature. People who travel internationally frequently along with those needing broad international medical coverage should opt for the Gap Comprehensive plan for its added benefits.

 

Oncology

• ✅ Medical expenses arising from cancer treatment become exceptionally high when medical scheme benefits prove insufficient to cover the entire cost. Discovery Gap Active delivers supplementary insurance coverage to approved oncology claims that exceeds medical scheme limitations at R75,000 per year. The benefit provides financial assistance to members when they require essential treatment because of its critical nature.

 

 

Discovery Vitality Health Benefit Extenders for Annual Hospital Admission

💙 All individuals are subject to an annual maximum of R210,580. However, the additional coverage you receive is determined by your family size, your Discovery Vitality Health status, and the type of health plan you have.

 

Discovery Gap Core

🟥 Family Structure	🟧 None / Blue	🟨 Bronze	🟩 Silver	🟦 Gold	🟪 Diamond
🧡 Single Member	R1,875	R2,345	R2,815	R3,280	R3,750
💛 Family	R3,750	R4,685	R5,625	R6,565	R7,500

 

Discovery Gap Comprehensive

Plan	Family Structure	None / Blue	Bronze	Silver	Gold	Diamond
MSA Plans	Single Member	R3,750	R4,685	R5,625	R6,565	R7,500
MSA Plans	Family	R7,500	R9,375	R11,250	R13,125	R15,000
Non-MSA Plans	Single Member	R1,875	R2,345	R2,815	R3,280	R3,750
Non-MSA Plans	Family	R3,750	R4,685	R5,625	R6,565	R7,500

 

 

How to apply for Gap Cover with Discovery Health

 

💙An active and current membership is required to apply for Gap Cover through Discovery Health.

 

• ✅ Visit the Discovery website and click “More Health Cover” from the homepage to apply.
• ✅ You must use your Username and password to log into the website.
• ✅ You have the option of requesting a quote or applying directly.
• ✅ Choose between the Discovery Gap Comprehensive and Gap Core programs.

 

👉 Complete the online application and await contact from Discovery Health.

 

 

How can I change my Discovery Health Gap Cover option?

✅ You may downgrade from Discovery Gap Comprehensive to Core with 30 days’ notice. This modification will become effective on the first day of the subsequent month following the notice period.

 

✅ Upgrades from Discovery Gap Core to Comprehensive can be requested at any time with a 30-day notice, and underwriting may apply.

 

 

How to Submit a Claim for Gap Cover with Discovery Health

✅ Discovery Health does not require a separate Discovery Gap Cover claim submission.

 

✅ Therefore, by granting access to your claims information, the scheme will automatically identify any potential gap cover claims and pay according to your Discovery Gap Cover benefits once the medical scheme claim has been processed.

 

 

 

Discovery Health Gap Cover Exclusions and Waiting Periods

 

👉  The following exclusions apply in terms of Discovery Gap Cover:

 

• ✅ Claims that are excluded by the medical scheme plan.
• ✅ Claims where hospital admission was not approved by the medical scheme and no authorization number, was obtained (except for in-hospital dentistry specialist claims).
• ✅ Claims that were not processed, approved, or covered by the medical scheme for any reason, including plan deductibles (exceptions for MRI and CT scans, endoscopies, and deductible for the TytoHome Kit for third-trimester maternity claims), exceeded plan limits or benefit entitlements, or not recognized as valid by the medical scheme.
• ✅ Claims defined as out-of-hospital claims by the medical scheme unless specified as an approved out-of-hospital claim that qualifies for funding from the policy’s Benefit Extenders
• ✅ Oncology-related co-payments that are part of innovative cancer treatments related to the medical scheme’s Oncology Innovation Benefit.
• ✅ Claims, where the Discovery Gap covers an overall limit of R185,000 per person per year, have been reached.
• ✅ Claims related to weight-loss surgery.
• ✅ Claims where healthcare service or treatment was not provided by a properly registered specialist (exception for services specified in the Gap Cover Comprehensive Benefit Extender).
• ✅ Claims incurred outside the borders of South Africa or charged in foreign currency (exception for claims that qualify for funding from the Travel Benefit Extender).
• ✅ Shortfalls on the medical scheme’s Overseas Treatment Benefit claims.

 

Out-of-pocket payments not covered by the medical scheme, such as deductibles, exclusions, and amounts claimed above health plan benefit limits (exception for co-payments and deductibles that qualify for funding as part of Discovery Gap Comprehensive’s Benefit Extenders).

 

Discovery Health Gap Cover Waiting Periods

 

💙Discovery Health applies waiting periods and exclusions to certain healthcare services starting from the policy start date and includes the following:

• ✅ Automatic three-month general waiting period for all healthcare services and treatment, except for authorized emergency hospital admissions.
• ✅ Automatic 12-month waiting period for any claims related to pregnancy and childbirth, endometrial ablations, joint replacements, scopes, cataracts, dental procedures, and other specified treatments.
• ✅ 12-month waiting period for claims related to pre-existing medical conditions if they are present at the time of policy application or upgrade.
• ✅ Waiting periods may be waived if the policyholder had gap cover with another insurance company for at least 6 consecutive months with no break in cover.

 

💙 For policyholders who downgrade their health plan, a 12-month condition-specific waiting period may apply to any new conditions after completing a health questionnaire.

 

 

Discovery Health Gap Cover vs. Other Notable Providers

🔎 Gap Cover Provider	🥇 Discovery Health	🥈 Sirago Gap Liberal	🥉 Stratum Benefits
🟥 Number of Plans	3	8	11
🟧 Average Price	R157	R172	R250
🟨 Waiting Periods	12 Months	3 months	3 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	✅ Yes	✅ Yes	✅ Yes
🟨 Scopes and Scans	✅ Yes	None	✅ Yes
🟩 Co-payment Cover	✅ Yes	✅ Yes	✅ Yes
🟦 Emergency Room	None	✅ Yes	✅ Yes
🟪 Accidental Cover	None	✅ Yes	✅ Yes
🟥 Trauma Counseling	None	✅ Yes	✅ Yes
🟧 Premium Waiver	None	✅ Yes	✅ Yes
🟨 Non-DSP Co-Payment	None	✅ Yes	✅ Yes
🟩 Prostheses	None	None	✅ Yes
🟦 Travel Cover Extender	None	✅ Yes	✅ Yes
🟪 Accidental Death/ Permanent Disability	✅ Yes	None	✅ Yes

 

 

Discovery Health Gap Cover Pros and Cons

✅ Pros	❌ Cons
Discovery gap cover provides cover for the difference between what medical practitioners charge and what medical aids pay, which can help to minimize out-of-pocket expenses	Gap cover is an additional expense on top of what is already paid for medical aid, which may not be affordable for everyone
Discovery Health offers a range of gap cover options that are tailored to meet the needs of different policyholders, including options for individuals, families, and businesses	Gap cover does not provide full cover for all medical procedures, and policyholders may still be responsible for paying some out-of-pocket expenses
Discovery Health is a well-established and reputable insurance company that has a strong record of accomplishment of providing quality healthcare products and services	Gap cover policies can be complex, and it can be difficult to understand the cover and exclusions

 

 

Discovery Health User Reviews

 

Great Support.

✅ I contacted Discovery Health and had the pleasure of speaking with an agent from the health department. She was extremely cordial and was able to provide me with the assistance I needed. Unfortunately, during the call, the line was disconnected. However, the agent took the initiative to return my call, which is not common among customer service representatives. I was impressed with her level of customer service and appreciated her promptness in following up. – Penny Benton

 

Very Happy!

✅ I underwent diagnostic tests under anesthesia at a hospital and obtained an authorization number from Discovery Health. The consultant informed me that my plan required an upfront payment of R10,000 unless a PMB diagnosis confirmation could be obtained. She kindly offered to request my doctor’s practice for any relevant diagnostic results to waive the payment. Upon receipt of the medical report from my doctor, the R10,000 was successfully waived. – Ashton Bray

 

Exceptional.

✅ It is a privilege to be a member of Discovery Health. I have consistently experienced exceptional assistance and service with every interaction and have encountered no difficulties. Kudos to Discovery for their commendable performance. – Isabella Morris

 

 

 

Our Verdict on Discovery Health Gap Cover

💙 Discovery Gap Cover offers two flexible plans that help members cover the additional cost that their medical plan does not. The benefits offered by Discovery Gap cover are comprehensive and offer good value for money.

 

💙 Furthermore, Discovery is a reputable and well-regulated company with a good reputation and a proven record of providing quality services and healthcare options.

 

👉 You might consider advancing your healthcare knowledge about Health Insurance in South Africa

 

Discovery Health Gap covers Frequently Asked Questions

 

What is Gap Cover with Discovery?

Discovery Gap Cover helps you cover unexpected medical expenses, such as when healthcare professionals charge more than your medical scheme covers or if a life-changing event occurs.

 

Is it worth having Gap Cover with Discovery Health?

Consider gap cover if you are concerned about costs and do not have much cash to pay for medical expenses.  According to independent financial advisers and certain healthcare professionals, gap cover is required for medical aids that do not cover all costs or all costs in full.

 

Can I cancel my Discovery Gap Cover policy at any time?

Yes, you can cancel your Gap Cover policy at any time. However, depending on your policy terms and conditions, you may be subject to cancellation fees or other charges.

 

How do I claim from Discovery Gap Cover?

You are not required to submit a separate claim for Discovery Gap Cover. Discovery Health has access to its members’ claim information and will automatically apply gap cover where members are eligible.

 

What is the average Discovery Gap Cover cost per month?

Gap Cover with Discovery starts from R157 per month.

 

How does Discovery Gap Cover differ from Medical Aid?

Medical Aid is a type of insurance that covers the cost of medical services. In contrast, Gap Cover covers the difference between what medical aids pay for medical services and what medical service providers charge for those services.

 

Are there any Discovery Gap Cover exclusions?

Discovery Gap Cover excludes out-of-pocket expenses not covered by the medical plan, such as deductibles, exclusions, and amounts claimed more than health plan benefit limits.  Furthermore, ensure that you read the Gap Cover brochure for a comprehensive list of exclusions that might apply.

 

What is the Discovery Gap Cover waiting period?

There is an automatic three-month waiting period for all healthcare services and treatments, except for hospital admissions for authorized emergencies.