5 Best Gap Covers for Pregnancy

 

In this guide, we explore the 5 best gap cover options specifically designed to provide comprehensive maternity benefits. These plans cover various shortfalls, co-payments, and additional costs that may arise during pregnancy and childbirth. In this guide you will learn:

 

• ✅ The importance of gap cover for pregnancy
• ✅ The 5 best gap covers for pregnancy
• ✅ Frequently asked questions

 

By choosing the right gap cover, you can ensure financial peace of mind and focus on what truly matters – the health and well-being of both mother and baby. Let’s discover the top gap cover options available and what makes each one a standout choice for maternity-related expenses.

 

 

The Importance of Gap Cover for Pregnancy

 

🤰🏾 Pregnancy is a significant life event that often brings joy and excitement, but it can also come with substantial medical expenses. While medical aid schemes provide essential coverage for pregnancy-related costs, they may not cover all expenses, leading to out-of-pocket payments that can strain a family’s finances.

 

🤰🏾 This is where gap cover becomes invaluable. Gap cover is a supplementary insurance that covers the shortfall between what your medical aid pays and the actual costs charged by healthcare providers. For expectant mothers, this can mean the difference between financial peace of mind and unexpected financial burdens.

 

⚠️ A guide to the best medical aids for pregnancy.

 

🤰🏾 One of the primary areas where gap cover applies during pregnancy is in hospital bills. Many medical aids cover a portion of the hospital stay and delivery costs, but the fees charged by obstetricians, anaesthetists, and paediatricians can exceed the medical aid’s tariff rate, leaving a significant gap.

 

🤰🏾 Gap cover steps in to bridge this difference, so that that parents-to-be are not left with hefty bills during such a critical time. This is particularly vital for those who opt for private healthcare services, where the discrepancy between medical aid cover and actual costs can be substantial.

 

🤰🏾 Gap cover is also essential for covering costs associated with specialized treatments and procedures that might arise during pregnancy. Complications such as preterm labour, caesarean sections, and neonatal intensive care can incur unexpected expenses.

 

🤰🏾 While medical aids provide coverage for these scenarios, they often come with limits and co-payments. Gap cover provides a safety net, covering the additional costs and allowing parents to focus on the health and well-being of the mother and baby without the stress of financial worries.

 

🤰🏾 Overall, gap cover for pregnancy is a critical component of a comprehensive healthcare plan for expectant parents. It mitigates the financial risks associated with the gaps in medical aid coverage, which mean that families can afford the best possible care without unexpected expenses.

 

🤰🏾 By covering the shortfalls in hospital fees, specialist charges, and unforeseen complications, gap cover provides essential financial protection during one of the most important periods in a family’s life.

 

⚠️ Read more about the medical insurance for pregnancy

 

 

The 5 best gap covers for pregnancy

 

Below are our top picks for the 5 best gap cover providers that offer maternity benefits.

 

Discovery Health Gap Cover

 

 

Discovery Health offers comprehensive gap cover products designed to provide financial protection against medical expense shortfalls. These gap cover products are particularly beneficial for individuals who have medical aid plans but face additional costs not fully covered by their schemes.

 

Discovery Health’s gap cover aims to ensure that members are not burdened by unexpected out-of-pocket payments for in-hospital and selected out-of-hospital treatments, making healthcare more accessible and affordable.

 

 

Maternity Benefits Under Discovery Health Gap Cover

☑️ Discovery Health gap cover products offer specific maternity-related benefits to provide comprehensive support during pregnancy and childbirth. Here are the key maternity benefits:

 

Coverage for Hospital and Specialist Fees

☑️ Discovery Health gap cover products ensure that the shortfall between what the medical aid covers and the actual costs charged by obstetricians, gynaecologists, and anaesthetists for maternity-related hospital admissions is taken care of. This includes both natural and caesarean deliveries, ensuring that mothers-to-be do not face unexpected expenses.

 

Pregnancy-Related In-Hospital Benefits

☑️ In the event of complications that require in-hospital treatment, Discovery Health gap cover products provide additional financial protection. This means that both mother and baby receive the necessary medical care without incurring significant out-of-pocket expenses.

 

Co-Payments and Deductibles

☑️ Discovery Health gap cover also helps with co-payments and deductibles that are often required by medical aids for maternity-related procedures. This includes coverage for specific pregnancy and childbirth procedures that might otherwise result in substantial out-of-pocket payments.

 

 

What is the monthly premium for the Discovery Health gap cover plans?

The price for the gap cover plans from Discovery Health start from R143 per month depending on the plan you choose and the variables of your coverage.

 

 

What Is the Waiting Period for the Discovery Health Gap Cover Benefits?

 

When signing up for Discovery Health Gap Cover, the following waiting periods apply:

 

• 🤰🏽 General Waiting Period: A three-month waiting period during which no claims can be made, except for those related to accidents.
• 🤰🏽 Condition-Specific Waiting Period: A 12-month waiting period for claims related to pre-existing conditions. This includes any medical conditions for which advice, diagnosis, care, or treatment was received in the 12 months prior to the start date of the cover.
• 🤰🏽 Pregnancy Waiting Period: Pregnancy-related claims are subject to the same 12-month pre-existing condition waiting period if the pregnancy started before the cover began.

 

 

How to Claim for Discovery Health Gap Cover Benefits

 

To submit a claim for Discovery Health Gap Cover benefits, follow these steps:

 

• ✅ Use the Discovery Health app or website to scan and upload your claim documents.
• ✅ Download the Discovery Health app from the App Store or Google Play, log in, select “My cover,” then “Claims,” and use the “Scan claim documents” option.
• ✅ Log in to the Discovery Health website, navigate to the claims section, and upload your scanned documents.
• ✅ Scan your claim documents and email them to [email protected]. For claims with updated or additional information, send them to [email protected].
• ✅ Alternatively, you can mail your claim documents to PO Box 784262, Sandton, 2146.
• ✅ Track the progress of your claims, use the Claims Search tool on the Discovery Health website, call 0860 99 88 77, or SMS ‘Claim’ to 31347.

 

 

Discovery Health Contact Details

1 Discovery Place

Sandton

2196

 

 

Bonitas MedGap

 

 

Bonitas MedGap offers comprehensive gap cover products designed to protect members from medical expense shortfalls during hospitalisation and certain out-of-hospital procedures.

 

This supplementary insurance bridges the gap between what medical aids pay and the actual costs charged by healthcare providers, ensuring that members are not burdened with significant out-of-pocket expenses.

 

MedGap products are exclusively available to active medical scheme members and are not a substitute for medical aid membership.

 

Maternity Benefits Under Bonitas MedGap Cover

☑️ Bonitas MedGap provides specific maternity-related benefits that cover needs of expectant mothers.

 

 

Medical Practitioner Shortfall Benefit

☑️ Bonitas MedGap covers the shortfall between what medical practitioners charge and what the medical scheme pays, up to three times the scheme’s amount.

☑️ This benefit is applicable to in-hospital procedures, which include childbirth. This means that the costs for obstetricians, gynaecologists, and anaesthetists are adequately covered, preventing unexpected expenses during delivery.

 

 

Co-Payment Benefit

☑️ This benefit covers the co-payments levied by medical schemes for approved in-hospital or out-of-hospital procedures.

☑️ For maternity-related procedures, this means that any upfront payments required by the medical scheme for hospital admissions or specific childbirth-related treatments are covered, easing the financial burden on expectant parents.

 

 

Baby Bump Benefit

☑️ Bonitas MedGap offers a fixed amount of R2,500 upon the diagnosis of pregnancy by a medical practitioner. This benefit is designed to assist with the unplanned expenses that may arise during pregnancy.

☑️ It provides immediate financial support to help cover initial costs associated with prenatal care and preparation for the baby’s arrival.

 

 

Additional Benefits

☑️ Bonitas MedGap also includes other benefits that can be indirectly beneficial during maternity. For example, the Casualty Benefit provides coverage for emergency visits to casualty wards, which can be crucial in the event of pregnancy-related emergencies.

☑️ The Premium Waiver Benefit means that in the case of the principal member’s accidental death or permanent disability, an amount is paid to cover medical scheme and gap cover premiums, providing financial stability for the family.

 

 

What is the monthly premium for the Bonitas MedGap plans?

The Bonitas MedGap plans start from R147 per month for students and go up to R695 per month depending on the plan you choose and your specifics.

 

 

What Is the Waiting Period for the Bonitas MedGap Benefits?

 

When signing up for Bonitas MedGap plans, the following waiting periods apply:

 

• 🤰🏽 3-Month General Waiting Period: Applies to private individuals not joining as part of an employer group. No claims can be made during this period.
• 🤰🏽 9-Month Pre-Existing Medical Condition Waiting Period: Applies to any procedure or surgery related to pre-existing conditions for which you have received advice or treatment in the 12 months prior to the cover start date.
• 🤰🏽 12-Month Waiting Period: Specifically for cancer, birth, or pregnancy-related claims.

 

 

How to Claim for Bonitas MedGap Benefits

 

• ✅ Obtain the claim form by emailing [email protected] or calling 0860 102 936, or download it from the MedGap website.
• ✅ Collect all related documents, including medical bills, statements, and any other required paperwork.
• ✅ Submit Online: Visit www.medgaponline.co.za to submit your completed claim form and related documents online.
• ✅ Email Submission: Alternatively, scan and email the completed claim form and documents to [email protected].
• ✅ Postal Submission: Mail the completed claim form and related documents to MedGap Claims, PO Box 786015, Sandton, 2146.
• ✅ Ensure all documents are submitted within 180 days from the date of treatment.
• ✅ For any enquiries, contact the claims department at 0860 102 936 or via the provided email address.

 

 

Bonitas Contact Details

34 Melrose Blvd

Birnam

Johannesburg

2196

 

 

Zestlife

 

 

Recognizing that healthcare providers often charge more than the amounts covered by medical aids, Zestlife offers several gap cover options for different needs and budgets.

These options mean that members are not left with substantial out-of-pocket expenses for in-hospital and specified out-of-hospital treatments. Zestlife Gap Cover is not a substitute for medical aid but complements it by covering the gaps, ensuring comprehensive coverage and financial peace of mind.

 

Maternity Benefits Under Zestlife Gap Cover

☑️ Zestlife Gap Cover includes specific benefits that address the financial challenges associated with maternity-related medical expenses. Here are the key maternity benefits provided by Zestlife Gap Cover options:

 

Medical Expense Shortfall Cover

 

• ✔️ Universal Gap Cover: Zestlife’s Universal Gap Cover provides extensive financial protection by covering medical expense shortfalls up to 500% of the medical aid tariff. This benefit covers in-hospital shortfalls on doctors and specialist charges for a wide range of procedures, including childbirth.

 

☑️ It ensures that the costs associated with obstetricians, gynaecologists, and anaesthetists are adequately covered, significantly reducing out-of-pocket expenses for maternity-related hospital stays.

 

• ✔️ Essential Gap Cover: The Essential Gap Cover option covers shortfalls up to 300% of the medical aid tariff. This option offers substantial coverage for maternity-related procedures, ensuring that expectant mothers are not burdened with significant medical expenses due to the gaps between what their medical aid covers and the actual costs charged by healthcare providers.

 

• ✔️ Optimal Gap Cover: Optimal Gap Cover, designed for single individuals under 35, covers shortfalls up to 400% of the medical aid tariff. This option provides reliable coverage for maternity-related medical expense shortfalls, making it an excellent choice for young, expecting mothers who may face substantial healthcare costs.

 

Co-Payment Benefit

☑️ All Zestlife Gap Cover options include a co-payment benefit, which covers the co-payments imposed by medical aids for hospital admissions and specified medical procedures. This benefit ensures that any upfront payments required by medical aids for maternity-related procedures are covered, alleviating the financial strain on expectant parents.

 

 

Casualty Facility Treatment for Injury in an Accident

While primarily focused on accidental injuries, this benefit covers treatment in a hospital casualty facility within 48 hours following an injury. This can be particularly useful for emergency situations that may arise during pregnancy, ensuring that mothers-to-be receive immediate care without worrying about the associated costs.

 

 

What is the monthly premium for the Zestlife gap cover plans?

The gap cover plans from Zestlife start from R506 per month and can go up to R770 per month depending on the plan you choose.

 

 

What Is the Waiting Period for the Zestlife Gap Cover Benefits?

 

When signing up for Zestlife Gap Cover, the following waiting periods apply:

 

• 🤰🏽 General Waiting Period: No general waiting periods apply after the commencement date of the policy.
• 🤰🏽 Pre-existing Condition Waiting Period: A 12-month waiting period applies for conditions where medical advice, diagnosis, care, or treatment was received in the 12 months before the start date of the cover.
• 🤰🏽 Pregnancy Waiting Period: Pregnancy and birth-related claims are excluded for 12 months if the pregnancy started before the cover commencement date.
• 🤰🏽 Extended Cancer Cover Waiting Period: A 6-month upfront waiting period from the date of commencement of cover for the optional Extended Cancer Cover.

 

 

How to Claim for Zestlife Gap Cover Benefits

 

• ✅ Download the claim form from www.zestlife.co.za or contact Zestlife to obtain a copy.
• ✅ Collect all related documents, including medical bills, statements, and any other necessary paperwork.
• ✅ Submit Online: Visit www.zestlife.co.za to submit your completed claim form and related documents online.
• ✅ Email Submission: Alternatively, scan and email the completed claim form and documents to [email protected].
• ✅ Postal Submission: Mail the completed claim form and related documents to the specified address provided by Zestlife.
• ✅ Ensure all documents are submitted within 180 days of the medical treatment giving rise to the claim.
• ✅ For expert advice or assistance, contact Zestlife on (021) 180 4220 / 0860 009 378 or email [email protected].

 

 

Zestlife Contact Details

Sunclare Building

21 Dreyer St

Claremont

Cape Town

7708

 

 

Stratum Benefits

 

 

Stratum Benefits provides a comprehensive range of gap cover products designed to bridge the gap between what your medical aid pays and the actual costs charged by healthcare providers. With Stratum Benefits, you can ensure that unexpected medical costs do not become a financial burden.

 

 

Maternity Benefits Under Stratum Benefits Gap Cover

☑️ Stratum Benefits offers several gap cover options that include maternity benefits to address the financial challenges associated with pregnancy and childbirth. Here are the key maternity benefits provided by Stratum Benefits Gap Cover:

 

 

Compact300 Gap Cover

☑️ Compact300 is an affordable option that provides significant coverage for maternity-related expenses:

 

• ✔️ Childbirth Shortfalls: Covers the shortfall between what the medical aid pays and the actual costs for both natural and caesarean deliveries.
• ✔️ Admissions and Procedures: Covers additional costs related to hospital admissions and procedures for childbirth.
• ✔️ Penalty Co-Payments: Covers co-payments imposed by the medical aid for not adhering to certain requirements, such as using a non-network hospital.

 

 

Meridian400 Gap Cover

☑️ Meridian400 offers mid-range coverage with several maternity-related benefits:

 

• ✔️ Childbirth Shortfalls: Covers up to 400% of the medical aid tariff for shortfalls related to natural and caesarean deliveries.
• ✔️ Admissions and Procedures: Covers costs associated with hospital admissions and specific maternity procedures.
• ✔️ Penalty Co-Payments: Covers penalty co-payments for non-network hospital usage and other conditions.

 

 

Elite500 Gap Cover

☑️ Elite500 is the top-tier option providing the most extensive maternity coverage:

 

• ✔️ Childbirth Shortfalls: Covers up to 500% of the medical aid tariff for natural and cesarean deliveries.
• ✔️ Admissions and Procedures: Covers extensive costs for hospital admissions and various maternity-related procedures.
• ✔️ Out-Patient Specialist Consultation: Covers out-patient specialist consultations related to maternity care.
• ✔️ Private Room Benefit: Provides coverage for the cost of a private room during hospital stays for childbirth.

 

 

Additional Benefits

☑️ All Stratum Benefits gap cover options include additional features that indirectly support maternity care:

 

• ✔️ Casualty Benefit: Covers treatment costs in a hospital casualty facility for emergency situations.
• ✔️ Trauma Counselling Benefit: Provides financial support for trauma counselling sessions, which can be beneficial for postnatal mental health.

 

 

What is the monthly premium for the Stratum Benefits gap cover plans?

Stratum Benefits has a range of price points starting from R275 per month and going up to R489 per month.

 

 

What Is the Waiting Period for the Stratum Benefits Gap Cover Benefits?

 

When signing up for Stratum Benefits Gap Cover, the following waiting periods apply:

 

• 🤰🏽 3-Month General Waiting Period: No claims can be made during the first three months of the policy, except for accidental injury claims.
• 🤰🏽 12-Month Pre-Existing Condition Waiting Period: No claims can be submitted for any medical procedures related to pre-existing conditions that were treated or diagnosed in the 12 months prior to the policy start date.
• 🤰🏽 10-Month Limited Payout Benefit: Applies to specific medical events, limiting the payout for these events during the first ten months of the policy.

 

 

How to Claim for Stratum Gap Cover Benefits

 

• ✅ Obtain and fill out the claim form, which can be downloaded from the Stratum Benefits website.
• ✅ Collect all necessary supporting documents, including the medical aid’s claims transaction statement, the healthcare provider’s account, and proof of payment if applicable.
• ✅ Submit Online: Visit the Stratum Benefits website and submit the completed claim form and supporting documents online.
• ✅ Email Submission: Alternatively, scan and email the completed claim form and all supporting documents to [email protected].
• ✅ Postal Submission: Mail the completed claim form and all related documents to the postal address provided by Stratum Benefits.
• ✅ Ensure all claims are submitted within 6 months from the date of the medical event.
• ✅ If additional documents are needed, submit them within 90 days. Claims are typically assessed within 10 working days of receiving all necessary information.

 

 

Stratum Benefits Contact Details

Stratum House

8 Fir Dr

Northcliff

Randburg

2195

 

 

Liberty Health

 

 

Liberty Health offers comprehensive gap cover products designed to protect medical scheme members from the financial burden of medical expense shortfalls. These products address the gaps that occur when healthcare providers charge more than the amounts covered by medical aids.

 

 

Maternity Benefits Under Liberty Health Gap Cover

☑️ Liberty Health’s gap cover options include significant maternity-related benefits to support expectant mothers. Here are the key maternity benefits provided by Liberty Health Gap Cover:

 

 

Universal Gap Cover

 

• ✔️ Childbirth Shortfalls: Covers up to 500% of the medical aid tariff for shortfalls associated with natural and caesarean deliveries. This ensures that the costs related to obstetricians, gynaecologists, and anaesthetists are adequately covered.
• ✔️ Pre and Post-surgery Specialists’ Consultations: Covers shortfalls on consultation fees charged by admitting medical practitioners before and after in-hospital surgery, including childbirth.
• ✔️ General Co-payments: Covers co-payments imposed by medical aids for hospital admissions, which are often required for childbirth-related procedures.
• ✔️ Non-network Co-payments: Covers co-payments for treatment in non-network hospitals or by non-network medical practitioners, up to R12,400 per policy per year.

 

 

Essential Gap Cover

 

• ✔️ Childbirth Shortfalls: Covers up to 300% of the medical aid tariff for shortfalls related to natural and cesarean deliveries.
• ✔️ General Co-payments: Covers co-payments imposed by medical aids for hospital admissions and specified procedures, including childbirth.
• ✔️ Casualty Facility Treatment for Injury in an Accident: Covers treatment costs in a hospital casualty facility within 48 hours following accidental injury, providing coverage for emergency situations during pregnancy.

 

 

Optimal Gap Cover

 

• ✔️ Childbirth Shortfalls: Covers up to 400% of the medical aid tariff for shortfalls associated with natural and cesarean deliveries.
• ✔️ General Co-payments: Covers co-payments imposed by medical aids for hospital admissions and specified procedures, including childbirth.
• ✔️ Non-network Co-payments: Provides coverage for co-payments when treated in a non-network hospital, up to R12,400 per policy per year.

 

 

What is the monthly premium for the Liberty Health gap cover plans?

The prices for the various plans from Liberty Health range from R239 per month to R770 per month.

 

 

What Is the Waiting Period for the Stratum Benefits Gap Cover Benefits?

 

When signing up for Liberty Health Gap Cover, the following waiting periods apply:

 

• 🤰🏽 12-Month Pre-Existing Condition Waiting Period: No benefits can be claimed for medical conditions that received medical advice, diagnosis, care, or treatment in the 12 months before the start date of the cover. This includes pregnancy and birth-related claims if the pregnancy started before the cover began.

 

 

How to Claim for Liberty Health Gap Cover Benefits

 

• ✅ Get the claim form from the Liberty Health website or contact your Liberty Financial Adviser.
• ✅ Collect all necessary documents, including medical bills, statements, and proof of payment if applicable.
• ✅ Submit your claim form to Liberty Health
• ✅ Contact Liberty Health’s support team for any queries or additional information regarding your claim submission.

 

 

Liberty Health Benefits Contact Details

The Straight Ave Grount Floor West

Block A

Pineslopes Office Park Lone Hill

Sandton

2194

 

⚠️ A guide to the overall best gap cover providers.

 

Frequently Asked Questions

Does gap cover include pregnancy?

✅ Yes, gap cover can include pregnancy-related benefits. These typically cover shortfalls between what your medical aid pays and the actual costs charged by healthcare providers for childbirth-related procedures, such as obstetrician and anaesthetist fees. However, specific benefits can vary depending on the gap cover provider and plan chosen.

 

Can I get medical cover while pregnant?

Getting new medical cover while pregnant can be challenging. Most medical aids and insurance providers consider pregnancy a pre-existing condition, which means pregnancy-related expenses may not be covered if the pregnancy began before the start date of the policy. It is important to check the terms and conditions of the medical cover or gap cover you are considering.

 

What cover do you need for pregnancy?

For comprehensive pregnancy coverage, you typically need:

• ✔️ Medical Aid Cover: This provides the base coverage for prenatal care, delivery, and postnatal care.
• ✔️ Gap Cover: To cover any shortfalls between the medical aid’s payout and the actual costs of procedures and treatments.
• ✔️ Maternity Insurance: Some insurers offer specific maternity policies that cover additional costs related to pregnancy and childbirth.

 

When should you get pregnancy cover?

It is best to get pregnancy cover before you become pregnant. This ensures that you avoid waiting periods and pre-existing condition exclusions that might limit your coverage. Ideally, you should have comprehensive medical and gap cover in place well before planning a pregnancy.

 

Is gap cover worth it?

✅ Yes, gap cover can be very worth it, especially for those who frequently require medical care that incurs high costs. It ensures that you are not left with significant out-of-pocket expenses for procedures and treatments that are only partially covered by your medical aid. This includes maternity-related expenses, which can be substantial.