19 Jun What is gap cover really, and do I need it if I have medical aid?
You’ve taken the responsible step of getting medical aid. Great! But here’s something many people don’t realise: even the best medical schemes often don’t cover all your in-hospital costs. That’s where GapCover® comes in: a simple, smart safety net that fills in the financial “gaps” your medical aid leaves behind.
If you’re not sure what gap cover is or whether you need it, you’re not alone. Let’s break it down together, clearly, calmly, and without the scary fine print.
1. Understanding the basics: What is GapCover?
GapCover® is short-term insurance that helps you pay for the difference between what your medical aid covers and what private healthcare providers actually charge, especially specialists for in-hospital care and procedures.
Let’s say your surgeon charges 300% of the medical aid rate, but your scheme only pays 100%. You’re left to pay the remaining 200%, unless you have GapCover® to bridge the medical aid shortfall.
2. Medical aid vs gap cover: What’s the difference?
Think of medical aid and GapCover® as a team.
- Medical aid pays for most of your healthcare needs, including hospital stays, day-to-day doctor visits, and chronic medication (depending on your plan).
- GapCover® kicks in after your medical aid has paid its portion, covering qualifying extra costs that your scheme doesn’t fully fund.
GapCover® doesn’t replace medical aid, it works with it, giving you an extra layer of protection.
3. Where medical aid falls short
Many people are surprised to find themselves facing unexpected bills, even after their medical aid has paid their portion. Common medical aid shortfalls include:
- Specialists charging more than medical aid tariffs
- Co-payments for certain procedures
- Non-network hospital penalties
- Medical aid shortfalls on dental surgery or diagnostic scopes
These costs can run into thousands of rands, and they’re usually payable upfront or immediately after discharge. That’s a stressful financial blow during an already tough time.
4. What exactly does GapCover help pay for?
GapCover® helps cover medical aid shortfalls for:
- In-hospital specialist charges that exceed medical aid tariffs
- Co-payments and deductibles
- Sub-limits on internal prosthetics
- Certain day procedures and diagnostic tests
- Dental surgery and oncology shortfalls
- Emergency casualty ward treatment (subject to conditions)
It’s designed to protect your finances when you need medical care most.
5. Is gap cover worth it if I’m young and healthy?
Absolutely. Emergencies, accidents, and unexpected surgeries don’t check your age first.
Having medical aid is smart. But having both medical aid and GapCover® is proactive. It’s about protecting your future self from the financial stress that can come with health surprises, no matter how fit or invincible you feel now.
Plus, the younger and healthier you are, the more affordable it tends to be.
6. Choosing the right GapCover plan for your needs
Start by asking:
- Do I use private hospitals or specialists?
- Is my medical aid on a network or hospital plan?
- Do I have a chronic condition or a family history of health issues?
- Do I want cover for dependants or just myself?
7. How GapCover fits into a smarter healthcare strategy
Medical expenses are one of the biggest threats to personal savings. A smarter healthcare strategy means thinking ahead. GapCover® gives you peace of mind knowing that you’re covered for major expenses before they happen. It’s not just insurance, it’s a financial buffer, a stress reliever, and a strategic health investment.
8. Final thoughts: Is gap cover right for you?
If you have private medical aid, the answer is likely yes. Here’s a quick checklist:
- I use private hospitals or specialists
- I’ve faced or worry about medical aid shortfalls
- I want to protect my savings from surprise bills
- I value peace of mind when it comes to healthcare
For more details or to sign up, visit GapCover.co.za.