10 Best Gap Covers in South Africa
The 10 Best Gap Covers in South Africa revealed.
We tested them side by side and verified their gap cover plans.
This is a complete guide to the best gap cover options in South Africa.
In this in-depth guide you’ll learn:
- What is Gap Cover?
- Why do you need gap cover in South Africa?
- Do you need gap cover if you have medical aid?
- Should you have gap cover when you have a hospital plan?
- What benefits does gap cover to give you?
- What is considered expensive for gap cover in South Africa?
So if you’re ready to go “all in” with the best gap covers in South Africa, this guide is for you.
Let’s dive right in…
Best Gap Covers in South Africa (2023)
|🩺 Medical Aid||✔️ Offers Gap Cover Options?||⚕️ Option||👉 Sign Up|
|1. Zestlife||Yes||Zestlife Universal Gap Cover||👉 Apply Now|
|2. Stratum||Yes||Stratum Benefits Access Optimiser Plus||👉 Apply Now|
|3. Turnberry||Yes||Premier||👉 Apply Now|
|4. Liberty Health||Yes||Liberty Essential Gap Cover||👉 Apply Now|
|5. Ambledown||Yes||Gap Cover 200||👉 Apply Now|
|6. Complimed||Yes||Complimed Legacy Series||👉 Apply Now|
|7. Xelus||Yes||Fusion||👉 Apply Now|
|8. Sirago||Yes||Sirago Gap-Lite Cover||👉 Apply Now|
|9. Discovery Health Gap Cover||Yes||Discovery Gap Comprehensive||👉 Apply Now|
|10. Sanlam||Yes||Sanlam Comprehensive Medical Gap Cover||👉 Apply Now|
10 Best Gap Covers in South Africa Summary
- Zestlife – Overall, Best Gap Cover in South Africa
- Stratum – Offers High-Quality Gap Cover Product Alternatives
- Turnberry – Covers Full Hospitalisation Visits
- Liberty Health – Dependable Medical Scheme Top-Up Coverage
- Ambledown – Focus on Creating Socially Balanced Products
- Complimed – Multiple Benefits in One Policy
- Xelus – Cover Specialist Visits Out of Hospital
- Sirago – Offers Unique Niche Products
- Discovery Health Gap Cover – Monthly Premiums are Established Beforehand
- Sanlam – Most Presentence in More Than 30 African Countries
A quick look at gap cover
Gap cover is a temporary insurance policy meant to fill in the gaps in coverage for those who currently have medical help. It covers the gap between your medical’s tariff (MST) and the actual prices charged by private healthcare professionals.
Doctors and specialists in South Africa can currently be reimbursed at 100%, 200%, or 300% of the scheme rate, depending on the medical insurance plan they have. However, licenced physicians can increase their fees by a factor of five.
Gap cover protects you and your loved ones from this disparity in coverage, which could result in significant out-of-pocket expenses in the event of a medical emergency.
The advantages of taking gap cover
Benefits up to 500% of the MST are provided by the best gap coverage policies both in and out of the hospital. They might also pay for your share of the cost of a hospital stay, specific surgeries, and diagnostic imaging.
Many South African medical aid plans require members to make out-of-network hospital co-payments. Gap cover will pay for this required annual co-payment up to a set limit per family.
If you have enough gap cover, you can get a lump payment to help pay for things like cancer treatment, an artificial organ, dental work caused by an accident, and care in a casualty department.
Gap cover waiting period: what you should know
Similar to conventional medical aid schemes, gap coverage has both waiting periods and exclusions.
There is typically a 12-month waiting time for pre-existing conditions and a 3-month general waiting period for other benefits. During certain intervals, you and your loved ones will not be covered.
Gap cover does not pay for all medical procedures and treatments. This varies with the credibility of the source. Commonly excluded services include those used to address obesity, as well as cosmetic procedures and dental specialties.
Co-payments expressed as percentages rather than rand amounts, claims older than six months, and any limit, co-payment, or penalty imposed by your medical aid scheme for noncompliance with scheme rules or authorisation procedures are all examples of what a gap cover provider might say “no” to when it comes to paying.
Zestlife is an authorised provider of financial services that concentrates on meeting your individual and family’s specific insurance needs. Death, disability, injury, or illness are all covered financially by Zestlife insurance.
Zestlife Gap Cover
Zestlife Gap Cover pays medical spending shortages that occur when medical aids do not pay doctor and specialist fees for in-hospital and some out-of-hospital procedures.
The difference between what medical aids cover and what private practitioners charge regularly amounts to tens of thousands of Rand losses, for which the patient is held responsible.
Hospital patients should focus on getting well rather than stressing about how to deal with unexpected medical costs that are not covered by medical aids. Zestlife Gap Cover pays for unforeseen medical expenditures, allowing patients to concentrate on getting back on their feet.
Zestlife Gap Cover Options
- Zestlife Universal Gap Cover provides the most complete medical bill shortfall coverage, as well as significant financial protection against a variety of health risks. This option is available as single or family coverage.
- Zestlife Essential Gap Cover provides low-cost coverage for the most common medical expense shortfalls, as well as supplementary financial protection for specific health risks. This option is available as single or family coverage.
- Zestlife Optimal Gap Cover provides excellent levels of coverage at an affordable price to meet the demands of people under the age of 35.
Stratum is a medical insurance firm. Constantia is the leading Underwriter of Gap Cover in South Africa, covering over 250 000 families and more than 480 businesses through its partner Stratum Benefits. Stratum Benefits has a diverse selection of high-quality Gap cover product alternatives.
Stratum Gap Cover
Stratum gap cover is the ideal answer for medical aid gaps. You can apply for Stratum benefits if you have affordable medical aid from one of the following schemes:
- Bonitas medical aid
- Discovery medical aid
- GEMS medical aid
- Genesis medical aid
- Hosmed medical aid scheme
- Medihelp medical aid
Stratum Gap Cover Options
- Base, Stratum Benefits’ entry-level gap insurance product, is an economical solution for people of all ages.
- If you choose the Elite gap cover package, you will be eligible for increased oncology-related benefits, enhanced co-payment, trauma and casualty cover, and a sub-limit benefit that reduces the cost of internal prosthesis, as well as MRI and CT scans.
- Stratum Benefits Access Optimiser Plus is a gap cover booster option. It covers particular medical procedures and occurrences that your medical aid plan does not cover.
Turnberry, formed in 2001, offers a variety of solutions best suited to your needs, giving unrivalled service while assisting you in avoiding the potential financial weight of expensive medical bill deficits.
Turnberry Management Risk Solutions (Pty) Ltd is an authorised Financial Services Provider (FSP no. 36571). Underwritten by Lombard Insurance Company, an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.
Turnberry Gap Cover
Turnberry Insurance Group provides a variety of solutions aimed to alleviate the financial pressures associated with medical bills during hospitalisation.
The majority of medical aids pay hospital expenses up to 100% of the medical aid rate. However, it is the fees charged by experts that can leave you out of cash if you do not have shortfall insurance. This is where Turnberry Gap Cover become a necessity.
Charges that exceed the recommended medical aid rate are covered by your policy. They offer up to 500% coverage. Co-payments are also covered in some cases.
Turnberry Gap Cover Options
- Premier serves as an umbrella for the complete family. It provides comprehensive cancer benefits as well as a wide range of benefits to cover unforeseen medical price gaps.
- Optimal offers a wide range of benefits, including increasing your medical aid by up to 500%, all at a family-friendly price.
- Synergy provides a wide range of health advantages at an affordable price. It protects you and your family against the most prevalent forms of claims and pays medical bill gaps up to 500%.
- Launch key benefits for specialists and cover medical spending gaps up to 350% of medical assistance rate. Launch is one of the most affordable Gap Cover options on the market.
- Med-Extend was created to help clients with medical spending gaps for Specialists as well as covering Defined Procedures that were previously prohibited from their individual Medical Scheme option.
- If you have extended family or an additional dependant registered on your Medical Scheme and they do not meet our definition of a “Family” as per the description above, you may add them to Med Extend.
- On request, Turnberry Policyholders can obtain international travel insurance through TIC. The coverage provides complete emergency help by air, land, or sea.
4. Liberty Health
Liberty Health was founded in 2008 and is a leading provider of health insurance to over 400 000 people in 27 African countries.
Liberty Health’s breadth of knowledge and expertise stems from their experience offering comprehensive, flexible health care solutions to multinational corporations, corporations, SMEs, and individuals in South Africa and throughout Africa.
The interests of the corporation include health insurance products as well as health administration technology systems and services.
Liberty Holdings includes Liberty Health. Liberty is a leading financial services firm on the African continent, having a Standard & Poor’s long-term rating of AAA.
Liberty provides a complete suite of long-term insurance products and services to address the evolving financial, investment, and lifestyle risk requirements of both the retail and corporate markets. Liberty Health Gap Cover is one of those products.
Liberty Health Gap Cover Options
Liberty Essential Gap Cover provides dependable medical scheme top-up coverage for the most common treatment cost deficits at a competitive price.
Coverage includes a low-cost Medical Expense Shortfall. In a calendar year, the policy provides coverage of up to R182 700 per person insured, as well as several health insurance benefits. The benefits of this gap cover include:
- In-hospital cover for doctor and specialist charges up to 3 times the medical scheme tariff
- Out-of-hospital cover for doctor and specialist charges up to 3 times the medical scheme tariff for approximately 50 out-of-hospital treatments.
- Medical scheme co-payment cover for hospital admissions, scans and certain surgical procedures, and
- Emergency Room Cover for accidental injury.
Ambledown Financial Services is the go-to provider of Gap Cover for over 150 000 policyholders and 1167 local and international businesses in South Africa. Ambledown also provides additional health insurance products and services that protect over a million people.
Ambledown focuses on creating socially balanced products by combining innovation, risk management, actuarial services, data analytics, and artificial intelligence.
Ambledown creates analytical tools and digital ecosystems to help members and brokers have a better, faster, and more efficient experience.
Ambledown Gap Cover Options
Ambledown is one of South Africa’s major providers of gap cover plans with over 150,000 Gap Cover (or equivalent) policy holders. Ambledown provides a range of gap cover plans to meet your specific requirements.
- Gap Cover 200 is available at R263 is limited to 3 times the Medical Scheme Tariff less the higher of the Medical Scheme Tariff or the Medical Scheme Option Reimbursement Rate.
- Gap Cover 100 is available at R382 per family per month 18 to 65 years old (Incl. Vat). The senior rate is R589 per family per month for entry age 66 years and old (Incl. Vat).
- Gap Plus is available at R481 per family per month 18 to 65 years old (Incl. Vat). The senior rate is R643 per family per month for entry age 66 years and old (Incl. Vat).
- Gap Select is available at R567 per family per month 18 to 65 years old (Incl. Vat). The senior rate is R841 per family per month for entry age 66 years and old (Incl. Vat).
- Gap Supreme is available R613 per family per month 18 to 65 years old (Incl. Vat). The product is not available to individuals 66+ years.
- LPE Advanced is available at R387 per family per month 18 to 65 years old (Incl. Vat). The senior rate is R574 per family per month for entry age 66 years and old (Incl. Vat).
- Ambledown Guardian is available at R203 premium is per family per month 18 to 65 years old (Incl. Vat). The senior rate is R288 per family per month for entry age 66 years and old (Incl. Vat).
Complimed, as experts in the Gap Cover business, has been assisting people and families in covering their medical insurance deficiencies in times of need since 2003. Their new Legacy Series plan will provide you peace of mind and complete coverage for practically any potential deficit.
Complimed Gap Cover products are affordable, accessible, easy to comprehend, and straightforward to claim from for the modern South African medical aid member.
Complimed Gap Cover Options
The Complimed Legacy Series is a comprehensive combination product
with multiple benefits built into one policy. It provides cancer benefits and significantly
enhances your Medical Scheme cover. Benefits include:
Medical Expenses Shortfall Cover
- Co-Payment Cover
- Non-DSP Hospital Penalty Cover
- Sub-limit Cover
- Trauma Recovery
Xelus gap cover was created expressly to cover the difference between the medical assistance rate and the rate that the specialist will charge you for a procedure if you are admitted to the hospital.
Xelus Gap Cover Options
Xelus has developed Fusion, a solution that provides you with additional benefits to safeguard you against shortages due to out-of-pocket expenses that your medical insurance would not cover.
Members of medical aid appreciate that Xelus offers a single solution for the gap cover market – Fusion.
No matter whose medical system you belong to or what plans you have, Fusion provides an ideal gap cover solution. The Fusion plan provides the following benefits:
- Where a co-payment is imposed by the medical aid scheme because the oncology benefit has been exceeded, Fusion will cover the co-payment up to a maximum of 20%, limited to the R275 000 policy limit per beneficiary per treatment cycle.
- Endoscopes – Any form of endoscopic procedure performed out-of-hospital that would otherwise, if performed in-hospital, attract a co-payment or deductible from the Medical Scheme.
- Dental extractions – Any form of surgical dental extraction performed out-of-hospital that would otherwise, if performed in-hospital, attract a co-payment or deductible from the Medical Scheme.
- Oncology – This relates to the fees of the oncologist and is in addition to the oncology co-payment cover above.
- Dialysis – This relates to the fees of a haematologist
- Home birth – This relates to the fees for a medical practitioner, nurse or mid-wife for a non-hospital birth
Sirago is dedicated to providing unique Gap Cover products to the South African market. Sirago pursues market opportunities in unique niche products as an underwriting manager.
Sirago’s product creation involves benefit determination based on medical scheme design, premium rating, policy language development, and distribution and marketing strategy.
GENRIC Insurance Company Limited, an authorised Financial Services Provider and registered Short-term Insurer, underwrites Sirago. Their core business is to provide crucial benefits to policyholders who are facing unexpected medical expense gaps that are not fully covered by their medical plans.
Sirago Gap Cover Options
- The Sirago Gap-Lite Cover was created for today’s busy households. To compensate for gaps in medical coverage, the scheme will pay up to R183,000 per year, or 250% of the scheme subscription.
- Hospital stays, imaging tests, surgical procedures, and visits to doctors who aren’t in your network may be eligible for financial assistance. Out-of-network PMB treatments, such as those received at day hospitals or doctors’ offices, are partially covered.
- Doctor visits and maternity care are among the benefits available to new parents and infants.
9. Discovery Health Gap Cover
Gap cover is available to all Discovery Health participants. Members’ monthly premiums are established by the medical aid plan in which they are enrolled. Anyone who isn’t already a Discovery Health member is ineligible for Discovery Health gap coverage.
Discovery Health Gap Cover Options
- Choose between Discovery Gap Comprehensive and Discovery Gap Core to cover shortfalls on approved in-hospital specialist claims and specific out-of-hospital costs related to an approved admission.
- You also get cover for co-payments on approved endoscopies, MRI and CT scans and cancer related claims. Your cover depends on the Discovery Gap Cover option you choose. An overall annual limit of R185 000 applies to each person.
- The Supplementary Illness Benefits provides lump-sum payouts, premium protection and home support when you need it most with an annual pay-back of your premiums of up to 25%.
Sanlam is a South African-based diversified financial services corporation with a substantial presence in more than 30 African countries, India, Malaysia, and a few developed markets. As part of its medical insurance cover, Sanlam provides gap cover products.
Sanlam Gap Cover Options
- The Sanlam Comprehensive Medical Gap Cover plan covers the primary member and all dependants on your medical aid at the point of claiming.
- Policyholders will only be able to claim R185,837 per year, for every insured individual on the policy.
- Hospital cash-back plans will be limited to paying their clients a maximum of R29,300 per year.
Frequently Asked Questions
What should I look for in a gap cover?
Some of the important aspects that you should consider when applying for gap cover include:
- Waiting periods
- Customer service
Is it worth it to get gap cover?
If you need to have an expensive medical treatment or disease that is not fully covered by your medical aid, gap cover can help make up the difference. Medical care is expensive, and many healthcare practitioners, such as specialists, charge rates that are greater than what medical aids are ready to pay.
What is gap cover for senior citizens?
This is a low-cost insurance product that covers medical aid recipients and their spouses. They are subsequently protected against any shortfall (Gap) caused by their health care provider charging more than the Medical Scheme Tariff for hospitalization-related incidents.
Is gap cover necessary in South Africa?
If you have a certified South African medical aid plan, gap cover is not a luxury; it protects you against such deficits and co-payments.
Does gap cover pay for medication?
Gap cover covers the deficits where doctors charge more than the medical aid rate and medical aid only pays up to the stipulated rate from the risk or hospital benefit. Gap cover cannot give coverage where medical aid does not pay for or pays the entire cost of a procedure.
You might also like to read our list of the 10 Best Medical Aid Plans in South Africa