Gap Cover

DIFFERENT gap cover products are available. A short description is given below.  Should you need more indepth explanations contact 0861 633 336

percentageGap cover is a short term insurance stated benefit product that covers the difference between the medical aid rate and private rates charged by doctors or specialists for in-hospital treatment.

If your medical aid covers you at 100% in hospital, Gap Cover will cover up to 400 or even 500%  over-and-above which your medical aid pays.

Anaesthetist, gynaecologist, radiologist, pathologist and other specialist surgeons are covered while in hospital.

Gap cover can be used with any medical aid.

Children are covered up to age 25 if studying, proof would be needed from the institution every year.

Co-payment cover is a benefit equal to charges in the form of a co-payment or deductible that applies to:in hospital

in-hospital admissions and/or
the necessity for chemotherapy or radiotherapy for the treatment of cancer on an outpatient basis and/or
outpatient procedures as defined in the policy document.

Hospital excess cover, charges in excess of R200, 000 for overall scheme and/or hospital limitation for in-hospital admissions in aggregate (the sum of all hospital confinements per family) per annum but limited to conditions that are not listed as a prescribed minimum benefit.


Cancer sub-limit gap, covers the sub-limitation imposed by the medical scheme for either the necessity for chemotherapy or radiotherapy for the treatment of cancer or biological cancer drugs, limited to Herceptin, Mylotarg, Nexaar, Gleevec, Sprycel, Fasodex, Velcade, Tarceva, Alimta, Zevalin, Avastin, Erbitux, Sutent, Fludara, Mabthera with specific oncological condition and/or specific sub-groups of cancers limited to the sub-groups of the following categories:

· HER 2+ breast cancer
· Acute myeloid leukaemia
· Advanced hepatocellular carcinoma
· Acute lymphoblastic leukaemia
· Chronic myeloid leukaemia
· Chronic lymphocytic leukaemia
· Hairy cell leukaemia
· Myelodysplasia
· HER –ve breast cancer
· Gastrointestinal stromal tumour
· Multiple myeloma
· Non-small cell lung cancer
· Non-Hodgkins lymphoma
· Metastatic colorectal cancer
· Advanced renal cell carcinoma
· Head and neck cancer


Such co-payment or deductible and/or sub-limitation amounts applied are as per the rules of the principal's registered medical scheme. No benefit shall be paid on any sub-limitation for conditions listed as a prescribed minimum benefit. Pre-existing cancer will be excluded when joining the policy.

In-hospital sub-limit cover provides you with an additional R20,000 per family per annum in the event that you exceed an in-hospital sub-limit as per your medical scheme option.

Contact us for more info 0861 633 336