GapCover® - Gap Cover (🇿🇦 2025)

Overall, GapCover® Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The GapCover® Gap Cover Plans start from R130 ZAR for the Gap Primary Plan. GapCover® has a trust score of 2.7. GapCover® has four plans to choose from

- GapCover® Elite
- GapCover® Combined
- GapCover® Primary
- GapCover®

😊 The average number of members	2,000+
1️⃣ Number of Markets	1
📊 Market Share	<1%
3️⃣ The number of plans offered	3
❤️ Customer Support Operating Hours	Monday to Friday, 8 am to 4h30 pm
⚠️ Waiting Period	3 – 12 months
⛔ Exclusions	✅ Yes

GapCover® Gap Cover - Analysis of Providers' Main Features

✅ GapCover® Features
✅ GapCover® Premiums
✅ GapCover® – Advantages over Competitors
✅ How to apply for cover with GapCover®
✅ How to Submit a Claim for Cover with GapCover®
✅ How can I change my GapCover® Option?
✅ GapCover® Waiting Periods
✅ GapCover® vs Other Notable Providers
✅ GapCover® User Reviews
✅ GapCover® Pros and Cons
✅ Our Verdict on GapCover®
✅ GapCover® Gap Cover Frequently Asked Questions

GapCover® Features

GapCover® Primary

✅ GapCover® Primary In-Hospital Benefits

🟥 Overall Annual Limit	The OAL is R198 660 per beneficiary per year.
🟧 Maximum Cover	Up to 500% of the medical scheme tariff.
🟨 Tariff Shortfalls	Provides policyholders with cover for the difference in what the Medical Professional charges and the Medical Scheme Rate paid while in the hospital.
🟩 Dental	Limited to R8,400 per policy per year. Covers shortfalls on all dental procedures covered from the risk.

✅ GapCover® Primary Out-of-Hospital Benefits

🟥 Overall Annual Limit	The OAL is R198 660 per beneficiary per year.
🟧 Maximum Cover	Up to 500% of the medical scheme tariff.
🟨 Tariff Shortfalls	Covers shortfalls relating to Gastroscopies and Colonoscopies performed in the doctor’s rooms. Limited to 2 scopes per beneficiary yearly.
🟩 Emergency Ward Benefits	Covers shortfalls for costs incurred on treating injuries caused by external forces in emergency wards. Limited to 2 events up to R6,500 per policy per year. Medical aid must cover the first amount before the policy will pay the shortfall.
🟦 Physiotherapy	Covers out-of-hospital physiotherapy up to R2,500 per policy year for post-operative joint replacement and spinal surgery rehabilitation. This cover is paid if the medical aid has paid for services rendered within the first month after the policyholder's discharge.

GapCover® Combined GapCover® Combined

✅ GapCover® In-Hospital Benefits

❤️ Overall Annual Limit	The OAL is R198 660 per beneficiary per year.
🧡 Maximum Cover	Up to 500% of the medical scheme tariff.
💛 Tariff Shortfalls	Provides policyholders with cover for the difference in what the Medical Professional charges and the Medical Scheme Rate paid while in the hospital.
💚 Co-Payments and Deductibles	Covers procedural co-payments required by medical aid for procedures performed as In-Patient. It also covers CT and MRI scans up to R17,500 per event. Non-DSP Co-payments are covered up to R17,000 per policy per year.
💙 Dental	Limited to R8,400 per policy per year. Covers shortfalls on all dental procedures covered from the risk. Covers co-payments on dental procedures up to R8,400 per policy per year.

✅ GapCover® Combined Out-of-Hospital Benefits

❤️ Overall Annual Limit	The OAL is R198 660 per beneficiary per year.
🧡 Maximum Cover	Up to 500% of the medical scheme tariff.
💛 Tariff Shortfalls	Covers shortfalls relating to Gastroscopies and Colonoscopies performed in the doctor’s rooms. Limited to 2 scopes per beneficiary yearly.
💚 Co-Payments and Deductibles	Covers procedural co-payments required by medical aid for procedures performed as Out-Patient. Covers co-payments involved with Gastroscopies and Colonoscopies, up to 2 scopes per beneficiary per year. It also covers CT and MRI scans up to R17,500 per event.
💙 Emergency Ward Benefits	Covers shortfalls for costs incurred on treating injuries caused by external forces in emergency wards. Limited to 2 events up to R6,500 per policy per year. Medical aid must cover the first amount before the policy will pay the shortfall.
💜 Physiotherapy	Covers out-of-hospital physiotherapy up to R2,500 per policy year for post-operative joint replacement and spinal surgery rehabilitation. This cover is paid if the medical aid has paid for services rendered within the first month after the policyholder's discharge.

GapCover® Elite

✅ GapCover® Elite In-Hospital Benefits

🔴 Overall Annual Limit	The OAL is R198,660 per beneficiary per year.
🟠 Maximum Cover	Up to 500% of the medical scheme tariff.
🟡 Tariff Shortfalls	Provides policyholders with cover for the difference in what the Medical Professional charges and the Medical Scheme Rate paid while in the hospital.
🟢 Co-Payments and Deductibles	Covers procedural co-payments required by medical aid for procedures performed as In-Patient. It also covers CT and MRI scans up to R17,500 per event. Non-DSP Co-payments are covered up to R17,000 per policy per year.
🔵 Dental	Limited to R8,400 per policy per year. Covers shortfalls on all dental procedures covered from the risk. Covers co-payments on dental procedures up to R8,400 per policy per year.

✅ GapCover® Elite Out-of-Hospital Benefits

🔴 Overall Annual Limit	The OAL is R198 660 per beneficiary per year.
🟠 Maximum Cover	Up to 500% of the medical scheme tariff.
🟡 Tariff Shortfalls	Covers shortfalls relating to Gastroscopies and Colonoscopies performed in the doctor’s rooms. Limited to 2 scopes per beneficiary yearly.
🟢 Co-Payments and Deductibles	Covers procedural co-payments required by medical aid for procedures performed as Out-Patient. Covers co-payments involved with Gastroscopies and Colonoscopies, up to 2 scopes per beneficiary per year. It also covers CT and MRI scans up to R17,500 per event.
🔵 Emergency Ward Benefits	Covers shortfalls for costs incurred on treating injuries caused by external forces in emergency wards. Limited to 2 events up to R6,500 per policy per year. Medical aid must cover the first amount before the policy will pay the shortfall.
🟣 Physiotherapy	Covers out-of-hospital physiotherapy up to R2,500 per policy year for post-operative joint replacement and spinal surgery rehabilitation. This cover is paid if the medical aid has paid for services rendered within the first month after the policyholder's discharge.

✅ GapCover® Elite Additional Benefits

🔴 Overall Annual Limit	The OAL is R198 660 per beneficiary per year.
🟠 Maximum Cover	Up to 500% of the medical scheme tariff.
🟡 Hospital Cash Back Benefit	When the insured is admitted to the hospital for accidental harm or premature birth, they qualify for the lump sum benefits. This benefit covers in-hospital stays as follows: Day 3 to 5 – R300 per day Day 6 to 10 – R400 per day Day 11 – 20 – R500 per day Maximum benefit of R25,000 per annum.
🟢 Oncology Benefit	Subject to the overall maximum compensation limit and the treatment involved with covered events. This equals the co-payment applied up to a maximum of 20% once all related costs are exceeded. Limited to R50,000 per policy per year.
🔵 Cash Back Bonus	Provides a once-off 10% cash back bonus of all premiums paid for the first 5 years of cover on GapCover Elite. This benefit is only available if no claims were made and the cover was never interrupted.
🟣 PMB Cover	Covers Non-DSP Specialist Tariff Shortfalls for all PMB admissions up to R14,150 per policy per year.
🔴 Sub-Limit Benefit	If a certain service charge exceeds a benefit sublimit of the policyholder’s Medical Scheme Benefit option, they could qualify for cover up to R42,250 per policy per year. Internal prostheses are limited to one claim per policy per year up to R31,750 per event. Specialized radiology is limited to 2 scans per policy per event, up to R5,250.
🟠 Accidental Dental Benefit	Covers Dental Reconstruction – limited to one claim per policy per year with damage resulting from oncology treatment or accidental harm. Limited to R6,900 per policy per year.

GapCover® Premiums

🔎 GapCover Plan	🥇 GapCover	🥈 GapCover Combined	🥉 GapCover Elite	🏅Gap Cover Primary
1️⃣ Individuals	From R234	From R318	R220	R130
2️⃣ Families	From R267	From R370	R338	R190

GapCover® for medical aid - Advantages over Competitors

💙The advantages of choosing GapCover® include:

✅ GapCover® provides additional financial protection for unexpected medical expenses that your medical aid plan may not fully cover.
✅ The plans from GapCover® provide a low-cost way to supplement your medical coverage because it covers the difference between what your medical aid pays and what healthcare providers charge.
✅ GapCover® provides various benefits, including cover for in-hospital specialist procedures, MRI and CT scans, and certain outpatient treatments.
✅ Claims are simple to file, and GapCover® pays directly to your healthcare provider, so you need not worry about paying the bills upfront.
✅ GapCover® provides flexible payment options, such as monthly and annual payment plans, to accommodate your budget.

GapCover® provides comprehensive cover for various medical procedures, giving you peace of mind that you are fully covered. GapCover even a better option

How to apply for cover with GapCover®

💙To apply for cover with GapCover®, you can follow these steps:

✅ Download an application form by visiting the GapCover® website or contacting them directly.
✅ Complete the application form with your personal information and medical cover details.
✅ Choose the GapCover® plan that meets your needs and budget the best.
✅ Send the completed application form and any required supporting documentation to GapCover® via email, fax, or mail.
✅ Several business days may be required for GapCover® to process your application.

As soon as your application is accepted, you will receive confirmation from GapCover® and can begin to enjoy the benefits of your chosen plan. GapCover We have the answers

How to Submit a Claim for Cover with GapCover®

💙Follow these steps if you need to submit a claim for Gap Cover with GapCover®:

✅ Obtain the claim form by visiting the GapCover® website or contacting them directly.
✅ Complete the claim form with your personal information and details about the medical service for which you submit a claim.
✅ Include all pertinent supporting documentation, including medical expense invoices and receipts.
✅ Email, fax, or mail the completed claim form and supporting documents to GapCover®.
✅ The processing of your claim by GapCover® may take several business days.

GapCover® will pay the agreed-upon amount directly to your healthcare provider or you if the claim is for out-of-pocket expenses once your claim has been approved. GapCover Options

How can I change my GapCover® Option?

💙If you need to modify your GapCover® option, you can do so by taking the following steps:

✅ Contact GapCover® directly to discuss changing your cover option.
✅ Provide your policy number and personal information to verify your identity.
✅ Explain to the GapCover® representative why you want to change your cover option and discuss the available options.
✅ If you decide to proceed with the change, the representative will walk you through the procedure and provide any additional information or documents that may be necessary.

Once the change has been processed and approved, GapCover® will send you a confirmation email, and your new cover option will become active. GapCover why wouldn't you get it

GapCover® Waiting Periods

💙The following can be expected from GapCover® in terms of waiting periods:

✅ All claims received during this period are subject to a 3-month general waiting period unless the claim results from an accident.
✅ A 12-month waiting period for pre-existing conditions shall apply to all pre-existing conditions.

Additionally, a full list of exclusions will be made available. GapCover Core Benefits

GapCover® vs Other Notable Providers

🔎 Gap Cover Provider	🥇 GapCover®	🥈 Zestlife	🥉 Stratum Benefits
🟥 Number of Plans	3	3	11
🟧 Average Price	R220	R253	R197
🟨 Waiting Periods	3 – 12 months	3 – 12 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	None	None	☑️ Yes
🟨 Scopes and Scans	✅ Yes	✅ Yes	✅ Yes
🟩 Co-payment Cover	☑️ Yes	☑️ Yes	☑️ Yes
🟦 Emergency Room	✅ Yes	✅ Yes	✅ Yes
🟪 Accidental Cover	☑️ Yes	☑️ Yes	☑️ Yes
🟥 Trauma Counseling	None	✅ Yes	✅ Yes
🟧 Premium Waiver	None	☑️ Yes	☑️ Yes
🟨 Non-DSP Co-Payment	Yes	✅ Yes	✅ Yes
🟩 Prostheses	None	☑️ Yes	☑️ Yes
🟦 Accidental Death/ Permanent Disability	None	✅ Yes	✅ Yes
🟪 Travel Cover Extender	None	None	☑️ Yes

GapCover® User Reviews

Helpful and Accommodating. The representatives are remarkably helpful and accommodating, swiftly addressing my query within a matter of minutes every single time. - Sonja Haddock Impressed. I have consistently been impressed by the efficacy of GapCoverSA and have no intentions of seeking services elsewhere. Thank you for your impeccable service. - Leon Groenewald Extremely Satisfied. I was extremely satisfied with the service rendered by GapCoverSA staff, who consistently exhibit a high level of professionalism and amiability in going above and beyond to assist me. - Anne-Marie Clarkson Peace of mind GapCover

GapCover® Pros and Cons

✅ Pros	❌ Cons
Covers up to 5 times (500%) the medical scheme tariff	Limited cover when compared to other gap cover providers
Plans cover the shortfalls, co-payments, and more	Does not cover maternity, trauma counseling, international travel, or medical cover

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Our Verdict on GapCover®

In our experience, GapCover® offers several valuable features and benefits to enhance your medical aid coverage. GapCover® offers three flexible plans that suit every budget and offer several benefits. One of the key advantages of GapCover® is that it covers up to 5 times (500%) the medical scheme tariff on shortfalls, co-payments, and other deductibles in and out-of-hospital. This means you can have peace of mind knowing you have extra protection against costly medical bills. We also found that GapCover® plans cover the shortfall between what your medical aid pays and what healthcare providers charge, which can help to reduce your out-of-pocket expenses. Furthermore, this is a standard feature regardless of whether you choose the Standard, Combined, or Elite options. GapCover® also offers a wide range of benefits, including cover for in-hospital specialist procedures, MRI, CT scans, and certain out-patient treatments.

GapCover® Gap Cover Frequently Asked Questions

What is GapCover®?

GapCover® is a gap cover provider that offers additional financial protection for unexpected medical expenses that your medical aid plan may not fully cover.

What does GapCover® cover?

GapCover® covers the shortfall between what your medical aid pays and what healthcare providers charge. This includes in-hospital specialist procedures, MRI and CT scans, and certain outpatient treatments.

How much does GapCover® cost?

The cost of GapCover® depends on your chosen plan but starts from R220 for GapCover® Elite for Individuals younger than 30.

How do I apply for GapCover®?

You can apply for GapCover® by visiting their website or contacting them directly to obtain an application form. Once you have completed and submitted the form, GapCover® will process your application.

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How do I submit a claim with GapCover®?

You can submit a claim with GapCover® by obtaining the claim form from their website or contacting them directly. First, complete the claim form with your details and attach any supporting documents, then submit it to GapCover® via email.

What are the waiting periods for GapCover®?

There are no waiting periods for any of the benefits offered by GapCover®, meaning you can claim immediately.

Is medical underwriting required to join GapCover®?

No medical underwriting is required to join GapCover®, which means that anyone can join, regardless of their health status. However, per terms and conditions, general waiting periods of 3 months and pre-existing conditions of 12 months will apply.

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