Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Is your gap cover aligned with your medical aid and your medical needs?

05 March 2024 Brian Harris, GM of Operations at Turnberry Management Risk Solutions
Brian Harris

Brian Harris

As medical expenses continue to inflate while medical aid cover increasingly has limitations, co-payments, and shortfalls, gap cover has become essential.

However, while gap cover plays a critical role in minimising medical expense shortfalls, it is vital to ensure, first and foremost, that your medical aid cover is suited to your needs, and that gap cover then slots in to ensure maximum coverage. Working with your broker or financial advisor to make sure you have the best products to fit with your lifestyle, life stage, and budget is important for any South African looking to safeguard their financial and physical wellbeing.

Gap cover works with your medical aid, not in isolation
The medical aid and gap cover landscape can be complex and difficult to navigate, which is why a broker is an invaluable ally. One thing that is important to understand is that getting the medical aid plan right is essential. Medical aid needs to offer the best cover for your needs and your budget, and this depends on many factors, including age, general health, chronic conditions, whether you have children, their ages, whether you are planning to have children, and so on.

Gap cover is then supplementary to cover shortfalls that are associated with medical expenses. For example, most medical schemes will pay 100% or 200% of the medical aid rate for medical treatments, but specialists typically charge between 300% and 600% of this rate. This could result in significant medical expense shortfalls, particularly when it comes to surgeries and specialised treatments like cancer. In addition, many medical aid plan options now include sub-limits and co-payments for various procedures, which can also lead to shortfalls. Gap cover can help to minimise or eliminate these shortfalls.

In addition to looking at the basics of gap cover, which is cover for medical expense shortfalls, cover for co-payments, and cover for sub-limits, it can also be beneficial to look at what other benefits gap cover offers. For example, some gap cover providers will offer a casualty benefit, which will cover expenses associated with treatment for casualties that do not result in hospital admissions. The claims process is also important. If claiming is difficult and requires significant effort, it will simply add more stress to your life unnecessarily. It can be helpful to understand a gap cover provider’s claims process and read reviews from actual clients to understand the experience.

Gap cover is for all ages and stages
It is never too early or too late to look after your financial and physical health, and gap cover (and medical aid) are not only for older people. Accidents and illness can happen to people of all ages, and as your life stage changes, so too will your needs. Medical expense shortfalls have the potential to cause significant financial hardship, so no matter where you are in life and what your needs are, aligning medical aid cover with gap cover is critical. Work with your broker to ensure your medical cover is right and that gap cover slots in effectively to provide the best protection possible, now and in the future.

Quick Polls


The shocking crime and motor vehicle accident statistics shared during a recent SHA presentation suggests that group personal accident and personal accident cover are a no-brainer. Do you agree?


Not sure
fanews magazine
FAnews April 2024 Get the latest issue of FAnews

This month's headlines

FAIS Ombud lashes broker for multiple compliance blunders
TCF… a regulatory misfit initiative?
The impact of NHI on medical malpractice insurance
Fixed versus variable: can you have your cake and eat it too?
The future world of work
Subscribe now