Gap Cover works alongside medical aid, but the terminology can be confusing. Use search or the A–Z filter, then tap a term to expand clear, plain-English definitions tailored for South Africans.
A
Bodily injury caused by violent accidental and external physical means.
E
A child, including a legally adopted child or stepchild, of a principal insured person who is an eligible dependent on the principal insured person’s medical scheme and who is not already insured. When such a child no longer satisfies these conditions, they cease to be covered under the policy.
The spouse of the principal insured person, registered as an adult dependant on their medical scheme and not already insured under similar cover. If more than one spouse qualifies, the principal insured person must make an irrevocable nomination of one eligible spouse.
A parent or sibling of the principal insured person who is registered as an extended adult dependant on the medical scheme and is not already insured under similar cover.
F
Includes the principal insured person, eligible spouse, eligible children, and eligible extended dependants, provided each is insured under the policy.
H
Any institution in South Africa or overseas which:
Provides diagnostic and therapeutic facilities for surgical and medical treatment under medical supervision.
Has nursing services supervised by registered nurses.
Is not primarily a mental institution, convalescent home, or rest facility for the aged, addicts, or those requiring long-term care.
Admission to a hospital ward, limited to General, Maternity, Private Wards, and Special Care Units.
I
Any somatic illness or disease manifesting during the insurance period, including degenerative changes, but excluding conditions undiagnosable by objective evidence.
Any accident or illness that causes an insured person to be confined to hospital and to undergo certain medical or surgical procedures.
The principal insured person or their eligible spouse, child, or extended dependant, provided they remain a member or dependant of a registered medical scheme.
M
A medical scheme registered under the Medical Schemes Act (131 of 1998) that provides insurance against medical expenses due to illness or injury.
Any procedure listed in the GAP Provider Tariff list.
A legally qualified and registered practitioner with the South African Medical and Dental Council.
T
Any investigation, consultation, or treatment by a medical practitioner for monitoring or managing an insured person’s medical condition.
The table published by the GAP provider consisting of procedure codes and corresponding tariffs.
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