Gap Cover

If you already belong to a medical aid. Why do you need Gap Cover?

You may think that if you're a member of a medical scheme you're fully covered for all hospital expenses, but in many instances, you're not.

In most cases there's a difference between what a speciaalist charges in hospital, and what your medical scheme will cover.

For example your medical scheme may pay up to R20,000 for a hospital procedure. In reality, these costs could be as high as R35,000 and escalate upwards.

These shortfalls can be high, especially for major procedures, and you might not have cash available to cover them. That's where Gap Cover comes in. Gap Cover pays for this shortfall so you're not out of pocket and don't suffer financially due to unexpected medical expenses. Gap Cover is typically restricted to procedures that take place in a hospital, but some out-patient services are also covered.


As a member of a Private Medical Scheme, you would expect that an event in hospital would be covered in full, this is so. Most Medical Schemes will cover in-hospital expenses defined as services rendered by a Medical Practitioner at the Medical Scheme rate. However, most specialists today are charging rates that are substantially higher than the Medical Scheme rates and you, as the member are liable for the difference. This is known as the tariff gap. In addition, Medical Aids often require a co-payment for a variety of procedures performed in hospital and/or impose limitations to certain medical/ sorgical procedures.

GAP SELECT is an Insurance Product that provides a selection of benefits, including Gap and Cancer Co-payment after a sub-limitation is imposed for cancer treatment in a private institution and the co-payment / deductible and sub-limitation benefit...





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