10 Best Gap Covers in South Africa (🇿🇦 2025*)

 

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 (2025)

🩺 Gap Cover	💶 Premiums Per Month	✔️ Variety of options	⚕️ Gap Cover Plan to consider
1. TRA	From R99	✅ Yes	Basic cover
2. iWyze	Premiums are determined based on the customer's age and risk profile	✅ Yes	iWyze Gap Cover
3. Elixi	From R282	✅ Yes	Elixi Single Gap Cover
4. Zestlife	From R253	✅ Yes	Zestlife Optimal Gap Cover
5. Stratum	From R197	✅ Yes	Compact 300
6. Kaelo	From R364	✅ Yes	Kaelo Gap
7. Sirago	From R172	✅ Yes	Plus Gap
8. Ambledown	From R245	✅ Yes	Guardian
9. Turnberry	From R169	✅ Yes	Synergy
10. Discovery Health Gap Cover	From R157	✅ Yes	Discovery Gap Comprehensive

 

10 Best Gap Covers – Trust Index Report

1. TRA – Reliable Gap Cover expertly crafted – Hello Peter Trust Index 9.7 – Very Likely recommended
2. iWyze – The wise solution – Hello Peter Trust Index 10.00 – Likely recommended
3. Elixi – Affordable and accessible – Hello Peter Trust Index 9.6 – Very likely recommended
4. Zest – Cover you can trust – Hello Peter Trust Index 7.9 – Likely recommended
5. Stratum – Gap Cover made easy – Hello Peter Trust Index 7.2 – Likely recommended
6. Kaelo – Simplified and diverse – Hello Peter Trust Index 7.5 – Likely recommended
7. Sirago – Tailored for unique requirements – Hello Peter Trust Index 4.7
8. Ambledown – Bridging the gap – Hello Peter Trust Index 3.2
9. Turnberry – Navigating the way – Hello Peter Trust Index 2.5
10. Discovery Health Gap Cover – Only available to Discovery Health Administered Medical Scheme members – Hello Peter Trust Index 8.5

 

 

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, licensed 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.

 

📢 Complete form and get a no obligation free quote

 

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 authorization procedures are all examples of what a gap cover provider might say “no” to when it comes to paying.

 

📢 Compare different medical aid quotes

 

 

1. TRA

 

💙 Total Risk Administrators provide Gap Cover policies that will bridge the gaps between what your medical aid covers and the real costs of the medical treatment one receives. And remarkably, all of TRA Gap Cover policies are designed in a way that they don’t allow a general three months waiting period for the members to start accessing their benefits.

 

Download the Total Risk Gap Cover 2025 here

 

👉 However, there are certain conditions applicable to specific waiting periods:

 

💙 Condition-Specific Waiting Period: For specified conditions, the waiting period is 10 months. Some of these are but not limited to the following:

 

✅ Head, neck, and spinal surgery, including laminectomy
✅ All the hernia operations
✅ Endoscopic examinations, such as colonoscopy, gastroscopy
✅ Pregnancy and confinement, also caesarean section
✅ A claim related to these conditions shall not be covered in that period.

 

💙Pre-Existing Condition Waiting Period: There is a six-month waiting period for any pre-existing medical conditions. The claims arising because of such pre-existing conditions are excluded from the cover within the period.

💙In the event that an Insured Party previously had a similar Medical Expense Shortfall Policy, not longer than 90 days before the inception of this Policy, the period of the 10 month Condition-Specific Waiting Period, 9 month Cancer Diagnosis Waiting Period, and 6 month Pre-existing Condition Waiting period (which run concurrently), may be reduced by the expired portion of the Condition-Specific Waiting Period/s served under such previous Policy.

For example, if the Insured Party was on a similar Policy previously within the last 90 days, for 7 months, they only have 3 months, 2 months and 0 months applied on the relevant waiting periods respectively.

A proof of membership certificate (showing the Join Date and length of cover/waiting period/s served) on the previous legitimate Gap Cover provider needs to be provided

💙 TRA has a range of Gap Cover options for every need and pocket, starting from as little as R99 per month, including:

✅ Basic Cover 300: From R99 pm
✅ Vital Cover Plus: From R360 pm
✅ Super Cover Plus: From R380 pm
✅ Absolute Cover Plus: From R620 pm
✅ Each of them is uniquely designed giving you an extra cover in addition to what your medical scheme covers. When selecting a Gap Cover provider, it’s advisable to shop based on the type of cover rather than the price of the cover.

 

TRA Contact Details

• ☑️ Phone: 011 372 1540

• ☑️ Email: [email protected]

• ☑️ Physical Address: 16 Jersey Drive, Longmeadow Business Estate (East), Edenvale, Johannesburg,1609

 

 

2.iWyze

 

 

💙 iWYZE Gap Cover is created to bridge the financial shortfalls that often arise between what your medical aid covers and the actual costs  during medical treatments. This Gap Cover ensure that unexpected medical expenses don’t become a financial loss.

 

👉 Download the Iwyze Gap Cover Brochure for 2025

 

 Key Features of  iWYZE Gap Cover:

• ☑️ In-Hospital Benefits: Covers up to 500% of the medical scheme tariff for in-hospital procedures, ensuring that specialist fees and other associated costs are adequately covered.

 

 

• ☑️ Oncology Benefits: Provides coverage for both in-hospital and out-of-hospital oncology treatments, including chemotherapy and radiotherapy, addressing potential shortfalls in cancer treatment costs.

 

 

• ☑️ Out-of-Hospital Benefits: Extends coverage to certain out-of-hospital procedures and treatments, ensuring comprehensive protection beyond hospital stays.

 

 

👉 Premiums for 2025:

💙  As of January 1, 2025, iWYZE Gap Cover policies are underwritten by GENRIC Insurance Company Limited. Premiums are determined based on the customer’s age and risk profile. For detailed information on the 2025 premium rates, it’s recommended to contact iWYZE directly or visit their official website.

Contact Details:

👉 For inquiries or assistance regarding iWYZE Gap Cover, you can reach out through the following channels:

• ☑️ Phone: 0860 93 94 93

• ☑️ Email: [email protected]

• ☑️ Physical Address: iWYZE Head Office, 1 Discovery Place, Sandton, Johannesburg, 2196

 

 

3. Elixi

 

 

 

4. Zestlife

 

Overview

💙 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.

 

 

💙 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.

 

💙 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.

 

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?

💰 Zestlife’s gap cover plans start at R253 per month and can go up to R838 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

✅  Phone: 021 180 4220 or 0860 009 378

✅  Fax: 021 180 4375

✅  Email: [email protected]

✅  Physical Address:

• Sunclare Building  2nd Floor
• 21 Dreyer Street
• Claremont
• Cape Town

 

 

5. Stratum

✅ 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.

 

📌 Download Stratum Gap Cover 2025 here

 

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:

 

Compact 300 Gap Cover

☑️ Compact 300 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 offers a variety of pricing options on different gap cover plans, ranging from R197 (Access Optimiser)  to R481 (Elite 500) for single person each 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

✅  Phone: 010 593 0981

✅  Fax: 086 633 3761

✅  Email: [email protected]

✅  Physical Address:

Stratum House

 8 Fir Drive

Northcliff

Randburg

2194

 

 

6. Kaelo

 

 

💙 Overall, Kaelo Gap – Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Kaelo Gap – Gap Cover Plan start from R364 ZAR. Kaelo has a trust score of 4.2.

 

💙 The Kaelo Gap is one of two plans that starts from R364 per month. The Kaelo Gap Plan has benefits for oncology, tariff shortfalls, sub-limits, penalties from using non-DSP hospitals, innovative oncology medicine, dental reconstruction, child casualty illness, and more.

 

🔎 Provider	🥇 Kaelo Gap
🟥 Years in Operation	19 years
🟧 Underwriters	Centriq Insurance Company Limited
🟨 Market Share in South Africa	<1%
🟩 Gap Cover Waiting Period	12 months
🟦 Do Exclusions Apply	✅ Yes
🟪 Average Monthly Premium	R364
🟥 Oncology Benefit	✅ Yes
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

 

Read more: Kaelo Gap Cover has two plans to choose from:

 

🟥 Individuals <60 years	R364
🟧 Individuals 60 years>	R519
🟨 Family <60 years	R659
🟩 Family 60 years>	R941

 

1. Kaelo Gap

2. Kaelo Gap Core

 

 

Kaelo Gap Benefits and Cover Breakdown

🟥 Overall Annual Limit	There is an overall annual limit of R185,537 per insured per year.
🟧 Tariff Shortfalls	Subject to the overall annual limit of R185,537 per insured per year.
🟨 Co-Payments and Deductibles	Covers diagnostic and medical procedure cover during hospitalization.
🟩 Shortfalls from Sub-limits	Limited to R60,900.
🟦 Oncology Tariff Shortfalls	The Oncology Shortfall Benefit covers up to 500% of the Medical Scheme rate to cover oncology treatment shortfalls.
🟪 Oncology Sub-Limits	Benefits are payable for oncology and related Treatment approved by the Insured Party's Medical Scheme for treating cancer (malignant neoplasm) during an Insured Event. The Benefit payable is equal to the charged amount less the amount paid by the Medical Scheme of the Insured Party.
🟥 Oncology Co-Payments	The Oncology Co-payment Benefit pays the 20% Oncology-Related Co-Payment imposed by the Medical Scheme.
🟧 Out-of-Hospital Tariff Shortfalls	Limited to an additional 500% of the medical scheme tariff.
🟨 Penalty Co-payment	Limited to per Family per year, with a maximum of R17,500 per event. Cover for penalty Co-payments or Deductibles that do not exceed 30% for the voluntary use of a non-Network Hospital by an Insured Party.
🟩 Innovative Oncology Medicines	As it relates to Innovative Oncology Medicines, a value equal to the lesser of 25% of the total drug cost, or R13,000, is covered. Cover for shortfalls in Innovative Oncology Medicines as defined by the Medical Scheme of the Insured Party.
🟦 Dental Reconstruction Benefit	Limited to two events per family per year. Limited to R49,900 per year.

 

💙According to our research, the Kaelo Gap plan is a comprehensive policy to supplement medical aid coverage and protect against shortfalls.

 

💙 It offers many benefits and extenders, including cover for tariff shortfalls, co-payments, deductibles, oncology-related expenses, out-of-hospital care, dental reconstruction, and innovative oncology medicines.

 

💙 We also found that it provides additional benefits in the event of premature birth, hospital stays, accidental harm, and child illness.

 

💙 The policy is flexible, extending your coverage regardless of the medical aid or plan option you have selected, and offers affordable premiums regardless of your family size.

 

Kaelo Contact Details

• ☑️ Phone: 0861 493 587
• ☑️ Email: [email protected]
• ☑️ Physical Address: 2nd Floor, The Oval – East Wing, Wanderers Office Park, 52 Corlett Drive, Illovo, 2196

 

⚠️ Read more about the best gap covers for pregnancy 

 

 

7. Sirago

 

 

Overview

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 authorized 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 is a good gap cover for the younger generation since it is designed for young individuals and families. Medical aid shortfalls are covered at up to 250% of the scheme rate, based on an overall annual limit of R213,000 per person.

 

Benefits include limited co-payment cover for hospital admissions, scans, surgical procedures and the use of non-designated service providers. There’s basic cover for the treatments of PMBs at non-DSPs and procedures conducted in day hospitals or doctors’ rooms.

 

It includes a cancer-boost benefit, new-born baby benefit, and emergency room and preventative care cover.

 

 

 

💙 The current monthly premiums for Sirago Gap Only are R289 for individuals of 64 years of age and younger.

 

Sirago Gap Cover Options

 

1. Gap Liberal

✅ This plan offers comprehensive gap cover benefits, including coverage for co-payments, sub-limits, and cancer-related treatments.

Individual Premiums:

• 💙 Ages 0-29: R172
• 💙 Ages 30-39: R202
• 💙 Ages 40-49: R229
• 💙 Ages 50-59: R320
• 💙 Ages 60+: R365

 

Family Premiums:

• 💙 Ages 0-64: R365
• 💙 Ages 65+: R365

 

2. Ultimate Gap Cover

Individual Premiums:

• 💙 Ages 0-29: R172
• 💙 Ages 30-39: R202
• 💙 Ages 40-49: R229
• 💙 Ages 50-59: R320
• 💙 Ages 60+: R365

 

Family Premiums:

• 💙 Ages 0-64: R365
• 💙 Ages 65+: R365

 

✅ This option provides extensive gap cover benefits, including coverage for co-payments, sub-limits, and cancer-related treatments.

 

Plus Gap Cover

Individual Premiums:

• 💙 Ages 0-29: R172
• 💙 Ages 30-39: R202
• 💙 Ages 40-49: R229
• 💙 Ages 50-59: R320
• 💙 Ages 60+: R365

 

Family Premiums:

• 💙 Ages 0-64: R365
• 💙 Ages 65+: R365

 

✅ This plan offers comprehensive gap cover benefits, including coverage for co-payments, sub-limits, and cancer-related treatments.

 

4. Gap Assist Cover

Individual Premiums:

• 💙 Ages 0-29: R172
• 💙 Ages 30-39: R202
• 💙 Ages 40-49: R229
• 💙 Ages 50-59: R320
• 💙 Ages 60+: R365

 

Family Premiums:

• 💙 Ages 0-64: R365
• 💙 Ages 65+: R365

 

✅ This option provides essential gap cover benefits, including coverage for co-payments and sub-limits.

 

5. Gap Core Cover

Individual Premiums:

• 💙 Ages 0-29: R172
• 💙 Ages 30-39: R202
• 💙 Ages 40-49: R229
• 💙 Ages 50-59: R320
• 💙 Ages 60+: R365

 

Family Premiums:

• 💙Ages 0-64: R365
• 💙 Ages 65+: R365

 

✅ This plan offers fundamental gap cover benefits, focusing on in-hospital shortfalls.

 

6. Gov Gap Cover

Individual Premiums:

• 💙 Ages 0-29: R172
• 💙 Ages 30-39: R202
• 💙 Ages 40-49: R229
• 💙 Ages 50-59: R320
• 💙Ages 60+: R365

 

Family Premiums:

• 💙 Ages 0-64: R365
• 💙 Ages 65+: R365

 

✅ This option is tailored for government employees, providing gap cover benefits that complement GEMS medical scheme options.

 

7. Exact with Gap and Co-Pay

Individual Premiums:

• 💙 Ages 0-29: R172
• 💙 Ages 30-39: R202
• 💙 Ages 40-49: R229
• 💙 Ages 50-59: R320
• 💙 Ages 60+: R365

 

Family Premiums:

• 💙 Ages 0-64: R365
• 💙 Ages 65+: R365

 

Sirago Contact Details

• ☑️ Phone: 010 599 1163
• ☑️ Email: [email protected]
• ☑️ Physical Address: Floor 2, Fauchard Clinic & Centre, Cnr. Jan Smuts & Jan Hofmeyer Ave, Florida Park, Roodepoort, Johannesburg, 1709

 

 

8. Ambledown

 

 

Overview

💙 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 R318 it 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 R466 per family per month 18 to 65 years old (Incl. Vat). The senior rate is R639 per family per month for entry age 66 years and old (Incl. Vat).

 

• ✅ Gap Plus is available at R588 per family per month 18 to 65 years old (Incl. Vat). The senior rate is R698 per family per month for entry age 66 years and old (Incl. Vat).

 

• ✅ Gap Supreme is available R748 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 R460 per family per month 18 to 65 years old (Incl. Vat). The senior rate is R623 per family per month for entry age 66 years and old (Incl. Vat).

 

 

•  Ambledown Guardian is ✅available at R245 premium is per family per month 18 to 65 years old (Incl. Vat). The senior rate is R315 per family per month for entry age 66 years and old (Incl. Vat).

 

 

Ambledown Contact Details

• ☑️ Phone: 011 882 8785

• ☑️ Email : [email protected]

• ☑️ Physical Address: 8 Ambledown Road, Sunningdale X8, Johannesburg, Gauteng, South Africa

 

 

9. Turnberry

 

Overview

💙 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 offers various Gap Cover products  from R169 per month that  would  safeguard  you against  unforeseen  medical  expenses  shortfalls not fully covered by your medical aid. Their plans are compatible with all registered open medical schemes and most closed schemes in South Africa, ensuring broad accessibility.

 

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.

 

Key Benefits Across Turnberry’s Gap Cover Plans:

 

💙 Medical Expense Shortfall Cover: Enhances your medical aid rate up to 600% for the cost of specialists, GPs, anesthetists, radiology, pathology, and other in-hospital services.

 

💙 Co-Payment Cover: Assists with the co-payments that your medical aid may request for specific treatments and procedures, therefore reducing out-of-pocket expenses.

 

💙Sub-Limit Cover: Extra cover when your medical aid has sub-limits for certain procedures or treatments, for comprehensive protection.

 

💙 Non-DSP Hospital Penalty Cover: Covers the penalties when treatment is sought in non-designated service provider hospitals, thus affording flexibility on choice of facilities.

 

💙The Turnberry gap cover protects clients and their families from bearing hefty medical expenses uncovered by their medical aid.

 

👉 Turnberry gap cover has the folloing plans to choose from:

 

 

• ✅ Turnberry Synergy
• ✅ Turnberry Premier
• ✅ Turnberry Optimal
• ✅ Turnberry Med Extend
• ✅ Turnberry Launch

 

 

10. 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 R157 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

• ☑️ Phone: 0860 99 88 77 (available 24/7)
• ☑️ Email: [email protected]
• ☑️ Physical Address:
  • Discovery Health Head Office
  • 1 Discovery Place
  • Sandton
  • Johannesburg
  • 2196

 

 

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:

• ✅ Coverage
• ✅ Premiums
• ✅ Waiting periods
• ✅ Benefits
• ✅ 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