The Best Medical Aids
The Best Hospital Plans
Overall, GapCover® Elite is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The GapCover® Elite Plan starts from R202 ZAR. GapCover® has a trust score of 5.1.
🔎 Provider | 🥇 GapCover® Elite |
🟥 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 | R202 |
🟥 Oncology Benefit | ✅ Yes |
🟧 In-Hospital Benefit | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes |
The GapCover® Elite is one of three plans that starts from R202 per month. The GapCover® Elite plan has benefits for emergencies, hospital cashback, oncology, PMBs, sub-limits, dental accidents, 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
🔎 Plan | 🥇 GapCover Elite |
🟥 Individuals <30 | R202 |
🟧 Individuals 30 – 59 | R303 |
🟨 Individuals 60> | R500 |
🟩 Families <30 | R301 |
🟦 Families 30 – 59 | R465 |
🟪 Families 60> | R765 |
🟥 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. |
🟥 Overall Annual Limit | The OAL is R183,000 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 |
🟩 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 R13,500 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 R40,000 per policy per year. Internal prostheses are limited to one claim per policy per year up to R30,000 per event. Specialized radiology is limited to 2 scans per policy per event, up to R5,000. |
🟧 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 R6,600 per policy per year. |
Discover the 5 Best Medical Aids with No Late Joiner Penalties
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:
A 12-month waiting period for pre-existing conditions shall apply to all pre-existing conditions.
🔎 Provider | 🥇 GapCover® Elite | 🥈 Elixi Family Double | 🥉 NetcarePlus GapCare |
🟥 Years in Operation | N/A | 6 years | 27 years |
🟧 Underwriters | Western National Insurance Company Limited | Unity Health | The Hollard Insurance Company Limited |
🟨 Market Share in South Africa | <1% | <5% | <5% |
🟩 Gap Cover Waiting Period | 3 – 12 months | 3 – 12 months | 3 – 12 months |
🟦 Do Exclusions Apply | Yes | Yes | Yes |
🟪 Average Monthly Premium | R202 | R243 | R285 |
🟥 Oncology Benefit | ✅ Yes | None | ✅ Yes |
🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes | ✅ Yes | ✅ Yes |
🟩 Maternity Benefit | None | None | ✅ Yes |
🟦 Scopes and Scans | ✅ Yes | None | ✅ Yes |
🟪 Co-payment Cover | ✅ Yes | None | ✅ Yes |
🟥 Emergency Room | ✅ Yes | ✅ Yes | ✅ Yes |
🟧 Accidental Cover | ✅ Yes | None | ✅ Yes |
🟨 Trauma Counseling | None | ✅ Yes | ✅ Yes |
🟩 Premium Waiver | None | None | ✅ Yes |
🟦 Non-DSP Co-Payment | ✅ Yes | None | ✅ Yes |
🟪 Prostheses | None | ✅ Yes | None |
🟥 Travel Cover Extender | None | None | None |
🟧 Accidental Death/ Permanent Disability | None | None | None |
According to our research, the GapCover® Elite is a comprehensive gap cover plan offered by GapCover®, providing benefits for emergencies, hospital cashback, oncology, PMBs, sub-limits, dental accidents, and more.
With premiums starting from R202 per month, it offers competitive pricing compared to other plans in the market. While there are currently insufficient reviews to establish a trust score, GapCover® Elite has been given a trust score of 5.1 based on experience.
GapCover® Elite is a comprehensive gap cover plan offered by GapCover® that provides additional financial protection for medical expenses not covered by your medical scheme.
The premiums for GapCover® Elite start from R202 per month for individuals under 30 years old and vary based on age and family status.
GapCover® Elite offers benefits for emergencies, hospital cashback, oncology, PMBs (Prescribed Minimum Benefits), sub-limits, dental accidents, and more.
GapCover® Elite covers in-hospital expenses such as tariff shortfalls, co-payments, deductibles, and certain procedures like CT and MRI scans.
GapCover® Elite covers out-of-hospital procedures, including tariff shortfalls for specific treatments, co-payments, and emergency ward costs for injuries caused by external forces.
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