NetcarePlus Gapcare Plans
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NetcarePlus GapCare
NetcarePlus Gapcare
· Gap Cover
Entry-level gap cover offering up to 500% medical scheme tariff for in-hospital specialist shortfalls, approved co-payments, cancer treatment, and essential hospital benefits.
Monthly premium
From
R345
per month
300+
NetcarePlus Gapcare
· Gap Cover
Mid-range gap cover providing up to 300% medical scheme tariff, with additional benefits including out-of-hospital specialist cover, day-to-day booster, and enhanced maternity benefits.
Monthly premium
From
R410
per month
500+
NetcarePlus Gapcare
· Gap Cover
Comprehensive gap cover offering up to 500% medical scheme tariff, plus extensive hospital, specialist, maternity, emergency, and day-to-day benefits for enhanced financial protection.
Monthly premium
From
R450
per month
NetcarePlus GapCare Gap Cover (🇿🇦 2025)
Overall, NetcarePlus GapCare Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The NetcarePlus GapCare Gap Cover Plans start from R315 ZAR on the GAPCARE Plan. NetcarePlus GapCare has a trust score of 4.1. NetcarePlus GapCare Gap Cover has three plans to choose from:| 👤 The average number of members | 5,000+ |
| 1️⃣ Number of Markets | 1 |
| 📈 Market Share | <5% |
| 3️⃣ The number of plans offered | 3 |
| ⏰ Customer Support Operating Hours | Monday to Friday – 8 am to 4 pm |
| ⚠️ Waiting Period | 3 – 12 months |
| ⛔ Exclusions | ✅ Yes |
NetcarePlus GapCare Gap Cover - Analysis of Providers' Main Features
- ✅ NetcarePlus GapCare Gap Cover Features
- ✅ NetcarePlus GapCare
- ✅ GapCare 300+
- ✅ GapCare500+
- ✅ NetcarePlus GapCare Gap Cover Premiums
- ✅ NetcarePlus GapCare Gap Cover – Advantages over Competitors
- ✅ How to apply for Gap Cover with NetcarePlus GapCare
- ✅ How to Submit a Claim for Gap Cover with NetcarePlus GapCare
- ✅ NetcarePlus GapCare Gap Cover Exclusions
- ✅ NetcarePlus GapCare Gap Cover vs Other Notable Providers
- ✅ NetcarePlus GapCare User Reviews
- ✅ NetcarePlus GapCare Gap Cover Pros and Cons
- ✅ Our Verdict on NetcarePlus GapCare Gap Cover
- ✅ NetcarePlus GapCare Gap Cover Frequently Asked Questions
NetcarePlus GapCare Gap Cover Features
NetcarePlus GapCare
NetcarePlus GapCare In-Hospital Benefits
| 🟥 In-Hospital Specialist Shortfall | Covers up to 500% of the medical aid scheme tariff. Includes approved medical procedures in specialist rooms, hospitals, and day hospitals. All consultations are covered when the insured person is hospitalized. |
| 🟧 Co-Payments and Deductibles | Covers upfront payments that medical schemes require for certain procedures, including scopes and scans (MRI, CT, etc.) performed in-hospital or when the insured person goes to a day clinic. The cover amount is either a fixed cost or a percentage of the overall cost. |
| 🟨 Cancer Treatment Benefits | NetcarePlus covers oncology shortfalls on related treatments when insured persons use a non-DSP. Co-payments are applied for certain cancer-related treatments. Co-payments will apply when the insured person reaches the oncology limit of their medical scheme. |
| 🟩 Out-of-Network/Non-DSP Hospital Co-pays | When the insured person uses a healthcare provider outside the medical scheme network voluntarily, NetcarePlus will cover the co-payment, and the following will apply: Unlimited hospital admissions within the NetcarePlus network. Limited to one hospital admission annually, up to R11,200 for healthcare facilities outside the NetcarePlus network. |
| 🟦 Charges Exceeding Sub-Limits | Sub-limits may be applied by the insured person’s medical aid regarding certain in-hospital medical procedures, prosthetics, the allowed stay in mental health institutions, rehabilitation, step-down or sub-acute facilities. Therefore, NetcarePlus will pay up to R35,000 for each insured person per year. |
| 🟪 Emergency Treatment in an Emergency Department | This covers insured persons when they require medical emergency treatment, including the following: Shortfalls on doctors’ claims up to 500% of the medical scheme tariff. Out-of-pocket expenses paid when the insured’s medical savings have run out or they reach their day-to-day sub-limit, are covered up to R20,000 per policy per year, subject to the overall annual limit. The following are covered under this benefit: Consultation fees for the doctor Facility fees Basic radiology, specialized radiology, pathology Medical appliances Medication |
NetcarePlus GapCare Maternity In-and Out-of-Hospital Benefits
| ❤️ Private Ward Cover | NetcarePlus covers the difference between the general ward fee that the insured’s medical aid covers and the private ward fee for a maternity admission, subject to availability. |
| 🧡 Hospital Birth | NetcarePlus covers the following if the insured chooses a hospital in the network: Maternity fees charged, including: “Back to Basics” book. One 4D Ultrasound. Netcare Baby Gift Bag. Mandatory Hearing Screening for newborns. First Baby Immunisations (BCG and Polio) One check-up visits two weeks after birth. 24-hour crisis line. Antenatal classes at a NetcarePlus network hospital. |
| 💛 Day-to-Day Maternity Benefits | NetcarePlus covers the difference between what the gynecologist/Obstetrician charges and the amount covered by the member’s medical aid for prenatal visits. When the member’s medical saving is depleted, or they have reached the day-to-day benefits of their scheme, NetcarePlus offers the following: Prenatal testing for high-risk pregnancies is limited to R25,000 for every pregnancy. Baby immunization per the latest government schedule. |
NetcarePlus GapCare Out-of-Hospital and Day-to-Day Benefits
| 🔴 Trauma Counselling | NetcarePlus will cover the following costs if a traumatic event occurs, up to R10,000 per insured per year, subject to the OAL: The difference between what the counselor/psychologist charges for counseling sessions and the amount the medical aid covers. The cost of counseling sessions with a counselor/psychologist once the insured person depletes their medical savings or they have reached their benefit limit. |
| 🟠 Premium Waiver | If the policyholder passes away or becomes permanently disabled following an accident, NetcarePlus will pay the GapCare Premium and Medical Aid Contribution for 6 months up to R5,000 a month. |
| 🟡 GapCare Emergency Booster | When medical emergency treatment is required, NetcarePlus will further cover the following: Doctor Consultation Fees Facility Fees Basic and Specialised Radiology and pathology Medical Appliances Medication R10,000 per policy per annum. |
GapCare 300+
NetcarePlus GapCare In-Hospital Benefits
| 🟥 In-Hospital Specialist Shortfall | Covers up to 300% of the medical aid scheme tariff. Includes approved medical procedures in specialist rooms, hospitals, and day hospitals. All consultations are covered when the insured person is hospitalized. |
| 🟧 Co-Payments and Deductibles | Covers upfront payments that medical schemes require for certain procedures, including scopes and scans (MRI, CT, etc.) performed in-hospital or when the insured person goes to a day clinic. The cover amount is either a fixed cost or a percentage of the overall cost. |
| 🟨 Cancer Treatment Benefits | NetcarePlus covers oncology shortfalls on related treatments when insured persons use a non-DSP. Co-payments are applied for certain cancer-related treatments. Co-payments will apply when the insured person reaches the oncology limit of their medical scheme. |
| 🟩 Out-of-Network/Non-DSP Hospital Co-pays | When the insured person uses a healthcare provider outside the medical scheme network voluntarily, NetcarePlus will cover the co-payment, and the following will apply: Unlimited hospital admissions within the NetcarePlus network. Limited to one hospital admission annually, up to R11,200 for healthcare facilities outside the NetcarePlus network. |
| 🟦 Charges Exceeding Sub-Limits | Sub-limits may be applied by the insured person’s medical aid regarding certain in-hospital medical procedures, prosthetics, the allowed stay in mental health institutions, rehabilitation, step-down or sub-acute facilities. Therefore, NetcarePlus will pay up to R35,000 for each insured person per year. |
| 🟪 Emergency Treatment in an Emergency Department | This covers insured persons when they require medical emergency treatment, including the following: Shortfalls on doctors’ claims up to 300% of the medical scheme tariff. Out-of-pocket expenses paid when the insured’s medical savings have run out or they reach their day-to-day sub-limit, are covered up to R20,000 per policy per year, subject to the overall annual limit. The following are covered under this benefit: Consultation fees for the doctor Facility fees Basic radiology, specialized radiology, pathology Medical appliances Medication |
NetcarePlus GapCare Maternity In-and Out-of-Hospital Benefits
| 🔴 Private Ward Cover | NetcarePlus covers the difference between the general ward fee that the insured’s medical aid covers and the private ward fee for a maternity admission, subject to availability. |
| 🟠 Hospital Birth | NetcarePlus covers the following if the insured chooses a hospital in the network: Maternity fees charged, including: “Back to Basics” book. One 4D Ultrasound. Netcare Baby Gift Bag. Mandatory Hearing Screening for newborns. First Baby Immunisations (BCG and Polio) One check-up visits two weeks after birth. 24-hour crisis line. Antenatal classes at a NetcarePlus network hospital. |
| 🟡 Day-to-Day Maternity Benefits | NetcarePlus covers the difference between what the gynecologist/Obstetrician charges and the amount covered by the member’s medical aid for prenatal visits. When the member’s medical saving is depleted, or they have reached the day-to-day benefits of their scheme, NetcarePlus offers the following: Prenatal testing for high-risk pregnancies is limited to R25,000 for every pregnancy. Baby immunization per the latest government schedule. |
NetcarePlus GapCare Out-of-Hospital and Day-to-Day Benefits
| ❤️ Out-of-Hospital Specialist Shortfalls | When the member’s medical aid has only paid a portion of out-of-hospital specialist consults, NetcarePlus will cover shortfalls for the following: Out-of-hospital consultations. Medical treatment is provided out-of-hospital. |
| 🧡 Day-to-Day Expenses Exceeding Medical Aid Limits | Once the insured member depletes their Medical Savings Account or they reach day-to-day benefit sub-limits, NetcarePlus will cover the following: Medical specialist consultations are required, deemed necessary by a GP. Basic Dentistry. Specialized Dentistry, including root canals, pulp removal, specialized x-rays, and reconstructive dentistry because of an accident and a trauma event. Specialized radiology and pathology deemed necessary by a GP or medical specialist for treatment or diagnosis. |
| 💛 Trauma Counselling | NetcarePlus will cover the following costs if a traumatic event occurs, up to R10,000 per insured per year, subject to the OAL: The difference between what the counselor/psychologist charges for counseling sessions and the amount the medical aid covers. The cost of counseling sessions with a counselor/psychologist once the insured person depletes their medical savings or they have reached their benefit limit. |
| 💚 Premium Waiver | If the policyholder passes away or becomes permanently disabled following an accident, NetcarePlus will pay the GapCare Premium and Medical Aid Contribution for 6 months up to R5,000 a month. |
| 💙 GapCare Emergency Booster | When medical emergency treatment is required, NetcarePlus will further cover the following: Doctor Consultation Fees Facility Fees Basic and Specialised Radiology and pathology Medical Appliances Medication |
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GapCare500+
NetcarePlus GapCare In-Hospital Benefits
| 🟥 In-Hospital Specialist Shortfall | Covers up to 500% of the medical aid scheme tariff. Includes approved medical procedures in specialist rooms, hospitals, and day hospitals. All consultations are covered when the insured person is hospitalized. |
| 🟧 Co-Payments and Deductibles | Covers upfront payments that medical schemes require for certain procedures, including scopes and scans (MRI, CT, etc.) performed in-hospital or when the insured person goes to a day clinic. The cover amount is either a fixed cost or a percentage of the overall cost. |
| 🟨 Cancer Treatment Benefits | NetcarePlus covers oncology shortfalls on related treatments when insured persons use a non-DSP. Co-payments are applied for certain cancer-related treatments. Co-payments will apply when the insured person reaches the oncology limit of their medical scheme. |
| 🟩 Out-of-Network/Non-DSP Hospital Co-pays | When the insured person uses a healthcare provider outside the medical scheme network voluntarily, NetcarePlus will cover the co-payment, and the following will apply: Unlimited hospital admissions within the NetcarePlus network. Limited to one hospital admission annually, up to R11,200 for healthcare facilities outside the NetcarePlus network. |
| 🟦 Charges Exceeding Sub-Limits | Sub-limits may be applied by the insured person’s medical aid regarding certain in-hospital medical procedures, prosthetics, the allowed stay in mental health institutions, rehabilitation, step-down or sub-acute facilities. Therefore, NetcarePlus will pay up to R35,000 for each insured person per year. |
| 🟪 Emergency Treatment in an Emergency Department | This covers insured persons when they require medical emergency treatment, including the following: Shortfalls on doctors’ claims up to 500% of the medical scheme tariff. Out-of-pocket expenses paid when the insured’s medical savings have run out or they reach their day-to-day sub-limit, are covered up to R20,000 per policy per year, subject to the overall annual limit. The following are covered under this benefit: Consultation fees for the doctor Facility fees Basic radiology, specialized radiology, pathology Medical appliances Medication |
NetcarePlus GapCare Maternity In-and Out-of-Hospital Benefits
| 🔴 Private Ward Cover | NetcarePlus covers the difference between the general ward fee that the insured’s medical aid covers and the private ward fee for a maternity admission, subject to availability. |
| 🟠 Hospital Birth | NetcarePlus covers the following if the insured chooses a hospital in the network: Maternity fees charged, including: “Back to Basics” book. One 4D Ultrasound. Netcare Baby Gift Bag. Mandatory Hearing Screening for newborns. First Baby Immunisations (BCG and Polio) One check-up visits two weeks after birth. 24-hour crisis line. Antenatal classes at a NetcarePlus network hospital. |
| 🟡 Day-to-Day Maternity Benefits | NetcarePlus covers the difference between what the gynecologist/Obstetrician charges and the amount covered by the member’s medical aid for prenatal visits. When the member’s medical saving is depleted, or they have reached the day-to-day benefits of their scheme, NetcarePlus offers the following: Prenatal testing for high-risk pregnancies is limited to R25,000 for every pregnancy. Baby immunization per the latest government schedule. |
NetcarePlus GapCare Out-of-Hospital and Day-to-Day Benefits
| ❤️ Out-of-Hospital Specialist Shortfalls | When the member’s medical aid has only paid a portion of out-of-hospital specialist consults, NetcarePlus will cover shortfalls for the following: Out-of-hospital consultations. Medical treatment is provided out-of-hospital. |
| 🧡 Day-to-Day Expenses Exceeding Medical Aid Limits | Once the insured member depletes their Medical Savings Account or they reach day-to-day benefit sub-limits, NetcarePlus will cover the following: Medical specialist consultations deemed necessary by a GP. Basic Dentistry. Specialized dentistry includes root canals, pulp removal, specialized X-rays, and reconstructive dentistry because of an accident and a trauma event. Specialized radiology and pathology deemed necessary by a GP or medical specialist for treatment or diagnosis. |
| 💛 Trauma Counselling | NetcarePlus will cover the following costs if a traumatic event occurs, up to R10,000 per insured per year, subject to the OAL: The difference between what the counselor/psychologist charges for counseling sessions and the amount the medical aid covers. The cost of counseling sessions with a counselor/psychologist once the insured person depletes their medical savings or they have reached their benefit limit. |
| 💚 Premium Waiver | If the policyholder passes away or becomes permanently disabled following an accident, NetcarePlus will pay the GapCare Premium and Medical Aid Contribution for 6 months up to R5,000 a month. |
| 💙 GapCare Emergency Booster | When medical emergency treatment is required, NetcarePlus will further cover the following: Doctor Consultation Fees Facility Fees Basic and Specialised Radiology and pathology Medical Appliances Medication |
NetcarePlus GapCare Cover Limits
| 🟥 Overall Annual Limit (OAL) | Limited to R205 000 per insured on the policy per year. |
| 🟧 Out-of-Network Hospital Co-Payments | Limited to one stay per insured person per year up to R11,200. Subject to the R205 000 OAL. |
| 🟨 Charged that Exceed Sub-Limits | Limited to R35,000 per insured person per year. Subject to the OAL. Limited to 5 days for stays in a mental health institution, rehabilitation, step-down or sub-acute facility. |
| 🟩 Emergency Treatment in an Emergency Department | Limited to R20,000 per policy per year. Subject to the OAL. |
| 🟦 Prenatal Testing for High-Risk Pregnancy | Limited to R25,000 per pregnancy. |
| 🟪 Day-to-Day Costs Exceeding Medical Scheme Limits | Limited to R20,000 per insured person per year. Subject to the R205,000 OAL. |
| 🟥 Trauma Counselling | Limited to R10,000 per insured person per year. Subject to the OAL. |
| 🟧 Premium Waiver | Limited to R5,000 per month up to 6 months for GapCover premiums and medical aid contributions |
| 🟨 GapCare Emergency Booster | Limited to R10,000 per policy per year. |
| 🟩Accidental disability | R10 000 per insured person per annum |
| 🟦Accidental death | R10 000 per death |
💙Discover more about the Best Medical Aids in South Africa Covering Dental Braces
NetcarePlus GapCare Gap Cover Premiums
| 🔎 NetcarePlus GapCare Plan | 🪙 Monthly Premium |
| 1️⃣ GapCare | From R315 per month |
| 2️⃣ GapCare 300+ | From 375 per month |
| 3️⃣ GapCare 500+ | From 415 per month |
NetcarePlus GapCare Gap Cover - Advantages over Competitors
💙The benefits of choosing NetcarePlus GapCare include the following:- ✅ NetcarePlus GapCare offers extensive coverage, providing policyholders peace of mind by covering the shortfall between their medical scheme's reimbursement rates and private healthcare provider rates.
- ✅ The policy offers generous annual limits of R185,000 per insured person annually.
- ✅ Policyholders are free to choose any healthcare provider, giving them flexibility and choice in selecting the healthcare services that best meet their needs.
- ✅ NetcarePlus GapCare offers many benefits, including cover for co-payments, deductibles, specialist fees, and more.
- ✅ Policyholders can benefit from the NetcarePlus network, which provides access to quality healthcare services and facilities and discounted rates on medical procedures.
- ✅ The policy covers a range of medical services, including hospitalization, day surgery, oncology, and more.
- ✅ NetcarePlus GapCare offers value-added services, including access to a medical emergency hotline and trauma counseling.
- ✅ The policy offers a waiting period waiver for policyholders who switch from another gap cover provider, provided the switch occurs within 90 days of leaving the previous provider.
- ✅ NetcarePlus GapCare is affordable, with competitive premiums and payment options, making it accessible to many South Africans.
💙Discover the 5 Best Gap Cover Options for Under R300
How to apply for Gap Cover with NetcarePlus GapCare
💙To apply for Gap Cover with NetcarePlus GapCare, you can follow these steps:- ☑️ Navigate to https://www.netcare.co.za/GapCover to access the NetcarePlus GapCare website.
- ☑️ Click the "Apply Now" button on the homepage to get started.
- ☑️ Include your personal and medical information on the online application form.
- ☑️ Choose the policy option that meets your needs best.
- ☑️ Select your preferred method of payment and provide the required payment information.
- ☑️ Examine your application and confirm that all information is accurate and complete.
- ☑️ Submit an online application.
- ☑️ After your application has been received and processed, a NetcarePlus GapCare representative will contact you to confirm it and provide any additional information you may require.
How to Submit a Claim for Gap Cover with NetcarePlus GapCare
💙To submit a claim for Gap Cover with NetcarePlus GapCare, you can follow these steps:- ✅ Obtain the required claim form from the NetcarePlus GapCare website or call their customer service center.
- ✅ Complete the claim form with accurate and comprehensive information regarding the medical service received, including the practitioner's information, the date of service, and the amount charged.
- ✅ Attach all pertinent documentation, such as invoices, statements, and receipts.
- ✅ Send NetcarePlus GapCare the claim form and all supporting documentation.
- ✅ NetcarePlus GapCare will evaluate your claim and notify you via email or mail of the outcome.
- ✅ If your claim is approved, NetcarePlus GapCare will deposit the approved amount directly into your bank account or, depending on the circumstances, pay the healthcare service provider directly.
NetcarePlus GapCare Gap Cover Exclusions
💙NetcarePlus GapCare has the following exclusions:- ☑️ Any claim excluded or not first processed by your medical scheme.
- ☑️ Any claim where the benefit-specific limits or overall annual limits per insured per year have been reached.
- ☑️ Events that occurred when you were not an insured person.
- ☑️ Events that occur during a policy waiting period unless it is for an accident or traumatic event.
- ☑️ Events where you did not obtain pre-authorization from your medical aid or did not follow your medical aid's rules.
- ☑️ Tariff codes other than procedure and consultation codes recognized by the medical scheme.
- ☑️ Any claim for healthcare services received outside the Republic of South Africa.
- ☑️ Any claim for healthcare services where the insured has neglected to use the NetcarePlus network if required.
- ☑️ Investigations, treatment, or surgery for weight loss or cosmetic surgery (surgery for breast reduction or reconstruction as a result of cancer treatment is included).
- ☑️ Any claim the Medical Scheme should cover, such as Prescribed Minimum Benefits, ward fees, theatre fees, medicines, appliances, and other hospital expenses.
NetcarePlus GapCare Gap Cover vs Other Notable Providers
| 🔎 Gap Cover Provider | 🥇 NetcarePlus GapCare | 🥈 Turnberry | 🥉 Ambledown |
| 🟥 Underwriters | The Hollard Insurance Company Limited | Lombard Insurance Company | Guardrisk Insurance Company Limited |
| 🟧 Number of Plans | 3 | 5 | 7 |
| 🟨 Average Price | R315 | R169 | R318 |
| 🟩 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 | ✅ Yes | 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 | None |
| 🟨 Premium Waiver | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟩 Non-DSP Co-Payment | ☑️ Yes | ☑️ Yes | None |
| 🟦 Prostheses | ✅ Yes | ✅ Yes | None |
| 🟪 Accidental Death/ Permanent Disability | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 🟥 Travel Cover Extender | None | None | None |
NetcarePlus GapCare User Reviews
Excellent Service. The level of service provided by the NetcarePlus agent I recently interacted with was commendable. The agent exceeded the expected duties to reach out to me and address all my inquiries satisfactorily. - Tanya Pather Satisfied Customer. I am extremely satisfied with the Gap cover offered by NetcarePlus, which has resulted in substantial savings. The fast, friendly, and professional service rendered by their staff deserves praise. - Helen Rosslyn Impressed. I recently raised a query regarding my claim entitlement with NetcarePlus. I was impressed with the promptness and accuracy of the response I received via email within a day. This contrasts the lengthy waiting time and less informative responses I experienced with my Medical Aid. I thank NetcarePlus for providing such efficient and helpful service. - Barbara van der Merwe
NetcarePlus GapCare Gap Cover Pros and Cons
| ✅ Pros | ❌ Cons |
| Extensive cover for the shortfall between medical scheme reimbursement rates and private healthcare provider rates | Exclusions for certain medical services and treatments |
| Generous annual limits | Exclusions for claims arising from excessive consumption of alcohol or professional sports participation |
| Freedom to choose any healthcare provider | Waiting periods for certain conditions and treatments |
