Specialist rates
Many specialists charge above medical-aid rates. Without gap cover, you can get a surprise bill after surgery.
Beyond medical aid
Gap Cover
When the scheme pays… and the specialist still invoices you.
Gap cover is separate shortfall insurance. Medical aid pays according to its rates and rules. Specialists and hospitals often charge more. That difference — the "gap" — is what can land on your account after a procedure.
What is gap cover?
It's cover designed to help pay the difference between what your medical scheme pays and what providers actually charge for in-hospital (and sometimes related) treatment. It sits alongside your medical aid — it does not replace it.
Why people buy it
Hospital shortfalls
Even on a solid hospital plan, co-payments, network rules, and tariff gaps add up fast.
Peace of mind
You keep your medical aid for day-to-day and hospital benefits — and use gap cover as a backstop for shortfalls.
How it typically works
- 1
You stay on a registered medical scheme (gap cover is not medical aid).
- 2
You take out a gap cover policy with waiting periods and benefit limits that apply.
- 3
If a claim creates a shortfall, you claim against gap cover for eligible amounts.
Exact benefits, exclusions, and waiting periods depend on the insurer and product. We'll walk you through the options before you buy.
Ready to add gap cover?
Tell us a little about you. We'll help you pick a suitable gap cover option and get the buy process started — no jargon marathon required.