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The Best Hospital Plans
Overall, GapCover® Combined is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The GapCover® Combined Plan starts from R292 ZAR. GapCover® has a trust score of 5.1.
🔎 Provider | 🥇 GapCover® Combined |
🟥 Years in Operation | N/A |
🟧 Underwriters | Western National Insurance Company Limited |
🟨 Market Share in South Africa | <1% |
🟩 Gap Cover Waiting Period | 3 – 12 months |
🟦 Do Exclusions Apply | Yes |
🟪 Average Monthly Premium | R292 |
🟥 Oncology Benefit | None |
🟧 In-Hospital Benefit | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes |
The GapCover® Combined is one of three plans that starts from R292 per month. The GapCover® Combined plan has benefits for co-pays, dentistry, physiotherapy, emergency room visits, scopes, scans, and more.
GapCover® offers 24/7 medical emergency assistance. There are currently insufficient reviews for the Trust Index to establish a trust score for GapCover®. However, based on our experience, we give it a trust score of 5.1.
GapCover® has two plans to choose from
🅰️ Option | 🅱️ GapCover Combined |
🟧 Individuals <30 | From R292 |
🟨 Individuals 30 – 59 | From R292 |
🟩 Individuals 60> | From R292 |
🟦 Families <30 | From R333 |
🟪 Families 30 – 59 | From R333 |
⬜ Families 60> | From R333 |
🟥 Overall Annual Limit | The OAL is R183,000 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 R17,000 per event. Non-DSP Co-payments are covered up to R16,500 per policy per year. |
🟦 Dental | Limited to R8,000 per policy per year. Covers shortfalls on all dental procedures covered from the risk. Covers co-payments on dental procedures up to R8,000 per policy per year. |
🟥 Overall Annual Limit | The OAL is R183,000 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 R17,000 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 R6,000 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 R2,000 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® does not currently publish its exclusions. However, some typical exclusions with gap cover include, but are not limited to, the following:
Any limit, co-payment, or penalty imposed on you by your medical aid scheme for non-compliance with scheme rules or authorization procedures
The following can be expected from GapCover® in terms of waiting periods:
🔎 Provider | 🥇 GapCover® Combined | 🥈 Sirago Gap Lite | 🥉 Kaelo Gap Core |
🟥 Years in Operation | N/A | 30 years | 19 years |
🟧 Underwriters | Western National Insurance Company Limited | GENRIC Insurance Company Limited (FSP: 43638) | Centriq Insurance Company Limited |
🟨 Market Share in South Africa | <1% | >10% | <1% |
🟩 Gap Cover Waiting Period | 3 – 12 months | From 3 months (up to 12) | 12 months |
🟦 Do Exclusions Apply | Yes | Yes | Yes |
🟪 Average Monthly Premium | R292 | R249 | R255 |
🟥 Oncology Benefit | None | None | None |
🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes | ✅ Yes | ✅ Yes |
🟩 Maternity Benefit | None | ✅ Yes | None |
🟦 Scopes and Scans | None | None | None |
🟪 Co-payment Cover | ✅ Yes | ✅ Yes | None |
🟥 Emergency Room | ✅ Yes | ✅ Yes | ✅ Yes |
🟧 Accidental Cover | ✅ Yes | ✅ Yes | ✅ Yes |
🟨 Trauma Counseling | None | None | None |
🟩 Premium Waiver | None | None | ✅ Yes |
🟦 Non-DSP Co-Payment | None | ✅ Yes | None |
🟪 Prostheses | None | None | None |
🟥 Travel Cover Extender | None | None | None |
🟧 Accidental Death/ Permanent Disability | None | None | ✅ Yes |
Our analysis of the GapCover® Combined plan shows that it offers a comprehensive range of benefits for medical expenses, including co-pays, dentistry, physiotherapy, emergency room visits, and more.
When comparing the GapCover® Combined plan with other gap cover options, it is important to note that it has a market share of less than 1% in South Africa. In addition, it has a waiting period of 3-12 months, similar to other plans, and exclusions do apply.
The GapCover® Combined plan offers benefits for co-pays, dentistry, physiotherapy, emergency room visits, scopes, scans, and more. In addition, it provides cover for in-hospital and out-of-hospital expenses.
The average monthly premium for the GapCover® Combined plan is R292. However, the premium may vary depending on age and family composition.
The GapCover® Combined plan has a waiting period of 3-12 months before certain benefits become active. Therefore, it is important to review the plan’s terms and conditions to understand the specific waiting period for each benefit.
The GapCover® Combined plan covers out-of-hospital expenses, such as procedural co-payments, gastroscopies, colonoscopies, CT and MRI scans, and emergency ward treatments. The overall annual limit is R183,000 per beneficiary per year.
Yes, the GapCover® Combined plan covers shortfalls incurred in emergency wards due to injuries caused by external forces.
However, the cover is limited to 2 events per year, up to R6,000 per policy per year. Medical aid must cover the initial amount before the policy pays the shortfall.
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