What is Gap Cover?


Healthcare providers are free to charge what they like and sometimes charge in excess of what your Medical Scheme will pay for a procedure, leaving you with the shortfall. Gap Cover is a short-term insurance product that provides cover for these shortfalls as well as co-payments, penalty fees or admission fees levied by your Scheme or the Hospital.


Why do I need Gap Cover?


The cost of healthcare in South Africa has risen over the years and Medical Schemes are unable to keep up. This has left many Medical Scheme members with short-payments that they need to cover or with expensive co-payments that are required before they can access benefit.


Gap Cover provides cover where the healthcare provider has charged more than the Scheme rate and the member is left with an amount to pay to the provider. This relates mostly to in-hospital events but there is also benefit for short-payment of consultations with GP's, Dentists, Specialists and a range of other healthcare providers. It is important to note that there is no benefit for shortfalls at pharmacies for chronic or acute medication.


Another valuable benefit provided by Gap Cover is the Co-payment, Admission Fee and Penalty Fee cover. This reimburses the policy holder for any co-payments, admission fees or penalty fees they are required to pay before accessing hospital benefit.


GapX also provides cover for cancer treatment and initial diagnosis as well as a range of value-added benefits like accidental death benefit and cover for your GapX or Medical Scheme premiums in the event of death or disability of the premium payer.