Go for the Gap

Near complete puzzle depicting Gap Cover


What on earth is Medical Aid Gap Cover? Think of it as the bridge on an unfinished highway: it's how you complete your hospital journey without doubling down on the pain.


Good idea: having a basic hospital plan to cover your family in the case of a medical emergency.

Bad idea: thinking that'll be enough to pay for your hospital expenses.


See, here's the rub: if you don't have Gap Cover (with a basic hospital plan, comprehensive plan or any type of Medical Aid), you may be faced with whopping private healthcare bills... even though you thought you were fully covered!


This can become especially important when you know that you will require hospitalisation. Seriously, there's no better time to take out Gap Cover than when you're expecting or if you're preparing to battle a cancer diagnosis, especially as there's typically a three-month waiting period.


Learn more: The Difference Between Medical Aid and a Hospital Plan


What is gap insurance and what does it cover?

It softens the blow of those 'fall-through-the-cracks' costs that even South Africa's best Medical Aid schemes don't fully cover on its own (to keep monthly payments affordable).


Let's take an anaesthetist's bill, for example. An anaesthetist can charge up to four or five times more than the Medical Aid rate (the amount you're covered for). This leaves you to settle the difference with a co-payment. This is where Gap Cover will kick in.


The same goes for co-payments on certain hospital procedures that your Medical Aid would be clear on from the jump like scopes, scans and dentistry.


Let's put it this way: you know that unfinished flyover bridge in Cape Town? That's the road equivalent of having normal Medical Aid. Sure, it'll cover part of your journey, but it won't get you all the way there. No matter how fancy your car (or Medical Aid) is, you might still need a bridge (Gap Cover) to reach your destination (by which we mean paying your full medical bill). Get it now? Great. You're a fast learner.


That's why it's a good idea to have Gap Cover — so that your bank balance doesn't hurt as much as you do when you go to hospital.


Gap Cover options

 Smiling man with missing front tooth


Here are the top-selling products per South African medical scheme, along with some typical co-payments to expect.


Top product: MediPhila
Price: R1,593
Popular cost saver for healthy young customers. Hospital cover limited to R1,000,000 per family in a hospital network. In-hospital specialist bills covered.
Co-payments: Numerous in-hospital procedures.


Top product: BonStart
Price: R1,338
Best for young adults wanting basic cover. Unlimited network GP and nurse virtual care consultations.
Co-payments: Some in-hospital procedures as well as out-of-hospital co-payments (that you can't use Gap Cover for)


Top products: MedVital Elect & MedMove!
Price: R1,650 and R1,452
MedVital Elect provides unlimited network hospital cover, with in-hospital specialist bills covered and acute injury benefits. MedMove! covers network private hospitalisation and emergency medical services.
Co-payments: MedVital Elect: specialised radiology, scopes and other in-hospital procedures.
MedMove!: Some in-hospital procedures as well as out-of-hospital co-payments (that you can't use Gap Cover for)


Discovery Health
Top product: Essential Smart Plan
Price: R1,600
Hospital plan with day-to-day benefits limited to a GP network. Acute and over-the-counter medicines, dental, eye tests, basic maternity benefits.
Co-payments: Various in-hospital procedures.


Top product: FlexiFED 1 Elect
Price: R1,481
Entry-level, cheaper hospital plan for single, healthy young adults. Unlimited network emergency hospitalisation and maternity cover at cost.
Co-payments: R12,500 on planned procedures.


*Want more options? Never fear, Hippo.co.za is here... to help make those med-aches disappear. Try our easy cost comparisons online.


Even with the top-selling products listed above, you'll still need Gap Cover if you don't want to fork out co-payment costs.


Less eina for you


Though each Gap Gover policy differs, expect two to five times what your Medical Aid will cover for a procedure, on top of the Medical Aid coverage. For example:


  • Specialist bill: R30,000
  • Medical Aid cover: R8,000
  • You pay: R22,000 (eina!)


So even if your Gap Cover takes care of 2X the Medical Aid payment:
That's R8,000 (Medical Aid) + R16,000 (Gap Cover) = R24,000.
You pay R6 000 (less eina!).


Now do you see why Gap Cover is worth investing in? Yip, we thought so!


Ah, but what about the monthly cost? We know. Countless surveys (and common sense) tell us that a top worry for average South Africans is how little is left in the kitty after month-end expenses. But just think of the expense you'll face without Gap Cover in a medical emergency.


Then think of how much a dent Gap Cover would really make with prices starting from around R99 for basic Gap Cover to about R495 for a more comprehensive plan for yourself. Once again, the numbers just make sense when it comes to Gap Cover. So plan now, thank us later.


Bin those shopping binges


Think of ways to curb your monthly spending and you'll be amazed at how much you save. Being savvier with your medical planning is a big step towards securing a safe future. Think of it as next-level adulting after getting Medical Aid.


So, if you're looking at reducing your monthly payments for Medical Aid, consider buying down and then adding Gap Cover. You can save even more by using Hippo.co.za's quick and easy platform to compare Medical Aid and Gap Cover. That flyover bridge might never be completed, but who cares? Your Gap Cover will get you where you need to go without the eina!


This article is for informational purposes only and should not be construed as financial, legal or medical advice.

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