What is Gap Cover and why do you need it?

Ever felt that sinking feeling when your Medical Aid doesn't cover the full cost of a procedure? A R90,000 surgery where your Medical Aid only pays R30,000 leaves you with a R60,000 bill to cover yourself.

Medical expenses in South Africa can be steep, and while Medical Aid helps, it doesn't always cover the full amount. That's where Gap Cover steps in: a financial safety net designed to keep you from paying large out-of-pocket in-hospital expenses.

But what exactly is Gap Cover, how does it work, and why should you consider it? Let's break it down in simple terms.

Hippo's quick bites:

1. Gap Cover is short-term insurance that pays the difference between what your Medical Aid covers and what your specialist actually charges.

2. Providers often charge well above Medical Aid tariffs, sometimes by hundreds of a percent, so even a good Medical Aid plan can leave you with a large shortfall.

3. Gap Cover closes that gap, but only works alongside Medical Aid, not instead of it.

Understanding Medical Aid rates

Medical Aid providers set a rate, called the medical scheme tariff (MST), that they're willing to pay for different treatments and procedures. The problem is that many healthcare providers charge well above these rates, sometimes up to 500% more. Medical Aids in South Africa typically cover between 100% and 300% of the MST, depending on your plan.

Let's say your Medical Aid covers an in-hospital procedure at R101,000, but the total cost is R153,000. Without Gap Cover, you'd be responsible for paying the remaining R52,000 out of pocket.

Even a top-tier Medical Aid plan can leave you with co-payments and sub-limits that add up to a hefty bill. This is where Gap Cover can make a real difference, so you're not caught off guard by unexpected expenses.

Something to Fill the Gap

Gap Cover is a short-term insurance product that fills the gap between what your Medical Aid pays and what your healthcare provider charges for in-hospital procedures. It's designed to stop you having to dip into savings or take on debt just to afford medical treatment.

Benefits vary by provider and can include:

• Paying the difference between what your specialist charges and what your Medical Aid covers, often up to 500% above MST

• Covering additional fees for procedures such as MRI or CT scans, which many Medical Aids only partially cover

• Helping with costs when Medical Aids impose limits on certain treatments, like internal prosthetics or ICU stays

• Covering shortfalls in chemotherapy, radiation therapy and other cancer treatments

• Covering emergency treatments that may not be fully covered by Medical Aid

• Trauma counselling, maternity cover or lump-sum pay-outs for serious illness, depending on the provider

Gap Cover isn't a replacement for Medical Aid. It works alongside it, so if you don't have Medical Aid, you won't qualify for Gap Cover.

Gap Cover Comparison

Note: Premiums and benefits are subject to change. Always consult directly with providers for the most current information.

Waiting periods differ by provider

Waiting periods are a key thing to check before choosing a Gap Cover policy. Here's how the providers above compare:

Note: Waiting periods change over time. Confirm current terms directly with each provider before publishing.

Compare Gap Cover quotes the easy way

Medical expenses are unpredictable, but being prepared can save you financial stress down the line. Gap Cover means that when life throws an unexpected medical bill your way, you're not left scrambling to pay it.

Instead of spending hours researching individual Gap Cover options, let us do the heavy lifting. Our online comparison tool lets you compare quotes from leading Gap Cover providers in South Africa, helping you find the best plan for your needs and budget.

This article is for informational purposes only and does not constitute financial, legal, medical or insurance advice. Hippo is a comparison site helping you evaluate quotes from trusted South African insurers. Always review policy details before making changes. Quotes are risk profile dependent and subject to annual review. No fees are charged for using Hippo’s comparison service. HAS (Pty) Ltd and HCS (Pty) Ltd are authorized FSPs. Terms and conditions apply.