29 Jul Why women trust GapCover when hospital bills hit hard

To many women, hospitalisation becomes much more than a medical experience; it is emotional, life-changing, and often draining financially. Whether you are about to give birth, faced with an emergency procedure, or just planning for an emergency that may come, medical aid always seems not to go far enough. That is why so many South African women rely on GapCover®, not only for backup but as a major partner in their healthcare journey.

Why medical aid alone isn’t always enough

Medical-aid schemes usually pay between 100% and 200% of the prescribed tariff, while doctors and specialists charge more than 500%, so there is a huge gap between what your medical scheme pays and what you are billed for. These tariff shortfalls are largely applicable during in-hospital procedures like childbirth, surgery, and emergency admissions.

And then there are the co-payments. Some costs must be borne by the patient because they lie outside the medical scheme-mandated prices usually through co-payments for particular procedures especially if patients elect to go to hospital/specialists outside of their Designated Service Provider (DSP) networks. It is these hidden or unexpected expenses that hit when you are least able to stand on your feet, and that is where GapCover® steps in.

What GapCover® offers women in hospital

GapCover® plans are designed to protect you from the financial strain of hospitalisation. Whether it’s a planned procedure or an emergency, here’s how you’re supported:

• Tariff Shortfall Cover: Get coverage for the difference between what your specialist charges and what your medical aid pays, up to 500%.
• In-Hospital Co-Payment Cover: For elective procedures, scans, and admissions, GapCover provides up to R17,500 per event.
• Non-DSP Hospital Co-Payments: If you choose a non-network hospital for a planned procedure, the right GapCover® plan helps cover the penalty.
• Emergency Casualty Ward Cover: Included in the Primary and Combined plans for those sudden, unplanned trips to the ER (unrelated to pregnancy).

While these protections apply across all GapCover® plans, only GapCover® Elite offers maternity-specific in-hospital benefits, designed with women in mind.

Pregnancy, labour and planned delivery: What GapCover® Elite covers

If you’re planning a pregnancy, GapCover® Elite gives you a safety net where medical aid may fall short:

• Pregnancy-Related In-Hospital Tariff Shortfalls: Covers shortfalls for obstetricians, gynaecologists, anaesthetists, and more during childbirth. Which is subject to your PMB Benefit.
• Planned Delivery Co-Payments at Non-DSP Hospitals: If you choose to give birth at a private hospital outside your scheme’s network, GapCover® Elite covers up to R17,500 per event.
• Hospital Cash Back Bonus: In the event of an emergency (such as premature birth or an accident resulting in hospitalisation), you could receive a daily cash benefit, up to R25,000 per policy, per year.

It’s important to know: during an emergency birth, your medical scheme cannot impose DSP penalties. But for planned births, many do and that’s where Elite shines.

Why preventative care still matters, and where it’s covered

Many women ask, “Does gap cover include things like mammograms, Pap smears, or antenatal check-ups?” The answer: not completely.

GapCover® offers limited cover for preventative screening tests, but only when partially paid for by your medical aid. These benefits don’t replace medical aid wellness cover, they complement it.

Here’s what’s included per year:

• Primary Plan: R500
• Elite Plan: R700
• Combined Plan: R1,250

Covered tests include:

• Full blood count
• Pap smear (women 15+)
• Mammogram (women 38+, every two years)
• Prostate screening (for men, 40+)

Preventative care like contraceptives or antenatal visits typically falls under your medical aid, not gap cover. But when used together, they create a more complete healthcare strategy, one that supports your wellness in both routine and high-stress moments.

Choosing the right GapCover® plan for your life stage

Not all women need the same level of coverage, and GapCover® offers flexible options to suit every stage of life:

• Primary Plan: Perfect for young women starting their health journey, offering essential shortfall protection at an affordable rate.
• Combined Plan: Ideal for women who want both shortfall and co-payment cover, plus emergency care.
• Elite Plan: Tailored for women planning a family or facing high-cost medical procedures, offering comprehensive in-hospital maternity and co-payment support.

Because hospital bills don’t care if you’re ready

Medical aid often gets you started, but it’s not always enough, especially when it comes to maternity or emergency hospital care. GapCover®, and especially GapCover® Elite, gives women the financial backup they deserve when hospital bills hit hard.

Don’t wait until you’re surprised by a shortfall or penalty. Choose the right gap cover for your needs, and move through life’s biggest health moments with confidence and care.