In South Africa, the costs of medical treatment keep rising, leaving many people questioning how to stay financially “in the green” when their medical aid just doesn’t seem to be enough anymore. By this, we mean that specialists tend to charge above medical scheme tariff rates, leaving South Africans needing to find a gap cover policy that will have their backs.
Unlike many gap cover providers, TRA does not impose a 3-month general waiting period* on its policies, making it ideal if you want gap cover with no waiting period on many claims.
Suppose you’re searching for the perfect Gap Cover policy for your medical aid that won’t require you to switch to a higher medical aid option (that STILL might not cover the shortfall). In that case, TRA’s no-general waiting period* for its policies makes for a sweeter, more cost-effective option for South Africans preparing for these sour, ever-rising medical expenses.
*While TRA does not impose a general waiting period, condition-specific waiting periods may apply.
Why Is Gap Cover Worth It?
Even the best, comprehensive medical aid plans can leave you paying out-of-pocket for medical aid tariff shortfalls. When specialists charge more than the medical aid covers, especially for in-hospital procedures and co-payments, your gap cover pays the difference. In TRA’s case, our policies can cover up to 700% above the medical aid tariff, and start as low as R99p/m depending on your plan.
This is where gap cover becomes “worth it”. While it isn’t a substitute for medical aid, it is complementary; gap cover is an insurance policy that ensures you aren’t left footing the bill for these medical insurance shortfalls.
For families, individuals with chronic conditions, or those navigating medical aid limits, gap cover offers critical financial protection.
How Gap Cover Works
A gap cover policy functions alongside your medical aid membership, covering medical expense shortfalls that arise when your medical aid pays less than what is charged. This means that members must have a medical aid scheme in order to qualify for gap cover.
Here’s what TRA’s gap cover is designed to cover (subject to your plan):
- Tariff shortfalls for in-hospital procedures
- Specific out-of-hospital treatments
- Co-payment shortfalls
- Oncology treatment shortfalls
- Shortfalls in authorised dental procedures
- Costs beyond medical aid limits, such as internal prostheses or scopes
Benefits of Gap Cover with TRA
With gap cover, you and your family will have peace of mind knowing that you are financially secure when unexpected medical expense shortfalls occur. In addition to this, TRA offers its policyholders benefits including:
- Travel insurance for policyholders under 71.
- Policy extender.
- Home Drive, trauma counselling, a panic button, and much more through the TRA Assist mobile app.
- Extended cancer cover benefit for females, including breast reconstruction (depending on the plan).
TRA offers four gap cover policy types:
Basic Cover 300, which covers up to 300% above medical aid tariffs.
- From R99 p/m for individuals and R180 p/m for families.
Vital Cover Plus, which covers up to 700% above medical aid tariffs.
- From R360 p/m for individuals and families.
Super Cover Plus, which covers up to 700% above medical aid tariffs.
- From R380 p/m for individuals and families.
Absolute Cover Plus, which covers up to 700% above medical aid tariffs.
- From R620 p/m for individuals and families.
Understanding Waiting Periods: Why They Exist
Waiting periods are an essential part of how medical schemes and insurance providers manage risk and ensure long-term sustainability. They are not designed to penalise members, but rather to prevent individuals from joining a scheme only when they require immediate medical attention, and then leaving once treatment has been received.
There are two main types of waiting periods allowed under the Medical Schemes Act:
1. Three-Month General Waiting Period
During this period, new members and their dependents are not entitled to any health insurance benefits, including claims for day-to-day medical costs or hospitalisation. However, there are exceptions. For example, if you change providers due to a change in employment or your employer switches providers, any unexpired waiting period from the previous scheme may be carried over, but no new one can be imposed. If you’ve had continuous medical aid cover for more than two years and switch schemes with less than a three-month break, you will still be covered for Prescribed Minimum Benefits (PMBs), such as emergency hospitalisation.
2. Twelve-Month Condition-Specific Waiting Period
This applies to any medical condition for which you have received advice, diagnosis, care, or treatment in the 12 months prior to joining a scheme. During this period, the scheme is not obliged to pay for treatment related to that specific condition.
This type of waiting period is typically applied if you’ve had a break in cover of more than three months, or if you haven’t been a member of a medical scheme for two years or longer.
The same waiting periods may apply to supplementary health insurance products such as gap cover.
Understanding TRA’s Gap Cover Waiting Periods
Although TRA does not apply a general waiting period of 3 months, there are some condition-specific waiting periods to note across all four plans:
Specific Waiting Periods
TRA applies only a 10-month waiting period (lower than the 12 months outlined by the Medical Schemes Act) for certain conditions and specific procedures, including but not limited to:
- Endoscopic scopes (e.g. colonoscopy, gastroscopy)
- Joint replacements
- Childbirth and gynaecological procedures
- Neurological, cardiac, and renal treatments
Cancer Waiting Period
If diagnosed with cancer prior to joining, a 9-month cancer-related waiting period applies. However, this may not apply if you’re in remission for 2+ years with supporting documentation.
Pre-Existing Conditions
There is a 6-month waiting period for pre-existing conditions that may result in hospital admissions, unless caused by an accident.
Cover Transfers
If you had previous medical expense shortfall cover and joined TRA within 90 days, certain waiting periods may be waived or reduced, depending on the policy documents and type of previous health insurance.
Submitting a Claim with TRA
TRA makes it easy to submit a completed claim form. You can submit through:
- The TRA Assist mobile app
- Online claim submission on the TRA contact us page
- Direct communication with the claims department via email – claims@totalrisksa.co.za
TRA runs three payment runs per week, so you can expect fast processing for valid claims.
Choosing the Right Gap Cover Provider
TRA is highly rated on HelloPeter and trusted for its transparency and service excellence.
When comparing gap cover options, look beyond monthly premiums—focus on:
- All the policy benefits
- Applicable waiting periods
- Coverage for certain procedures
TRA Gap Cover Has Your Back
Get gap cover insurance today and don’t be delayed with a general waiting period. With rising medical expenses and figuring out what exactly your medical scheme covers, it’s best to be prepared sooner rather than later.
TRA offers comprehensive gap cover policies to suit your budget, delivering value, flexibility, and real support when you need it most.
Don’t leave your health to chance. Contact TRA today to sign up for gap cover that protects you from the unexpected.
