Gap cover for Discovery medical aid pays the in-hospital shortfalls your medical aid does not. When a specialist charges 300% of the Discovery Health Rate but your plan only pays 200%, you cover the difference out of pocket. TRA gap cover could settle that gap for authorised in-hospital procedures, up to 700% of scheme tariff.
Discovery’s 23 plan options give strong hospital cover, but many plans still leave shortfalls behind on a lot of specialists accounts. TRA gap cover plans can plug those shortfalls. 2026 premiums start at R99 per month for the Basic Cover 300 individual policy.
These shortfalls are generally unavoidable when you have a medical scheme membership, because every scheme has predetermined tariffs that it will pay up to. When a specialist charges more, that is not in the medical aid’s control, and they will not adjust their coverage limits.
Why Discovery Members May Choose TRA Gap Cover
Discovery Health Medical Scheme is one of South Africa’s largest medical aid providers, with 23 plan options across seven series to suit different income levels and healthcare needs.
While the level of hospital cover is strong across all plans , with no overall limits on most plans, patients are still responsible for any shortfalls when specialists charge above the medical aid tariff.
TRA gap cover could help manage:
- Specialist charges that exceed what the medical aid pays
- Co-payments for in-hospital procedures and scans
- Cost differences for certain day clinic surgeries and scopes
- Oncology co-payments and sub-limit shortfalls during cancer treatment
- Unexpected medical payments not covered in full by the medical aid
Gap cover is especially valuable during hospital admissions and for high-cost treatments at private healthcare providers.
Gap Cover for Discovery Medical Aid by Plan Type
Discovery Health Medical Scheme offers a range of plans suited to various healthcare needs and budgets of South Africans. Here’s an overview of their plan structure:
Executive Plan
The Executive Plan provides comprehensive coverage including unlimited private hospital access and extended chronic medicine benefits. It offers in-hospital specialist cover up to 300% of the Discovery Health Rate (DHR).
Comprehensive Series
These plans offer extensive in-hospital and day-to-day cover, with in-hospital specialist services covered up to 200% of the DHR. They include a Medical Savings Account (MSA) and an Above Threshold Benefit for additional day-to-day expenses once the MSA is depleted.
Priority Series
Priority plans balance hospital cover and day-to-day benefits. They include an MSA and limited ATB, with in-hospital specialist cover up to 200% of the DHR.
Saver Series
Saver plans focus on in-hospital coverage with an MSA for day-to-day medical expenses. In-hospital specialist services are covered up to 200% of the DHR on Classic plans and up to 100% on Essential and Coastal plans.
Core Series
Core plans provide comprehensive medical coverage for hospitalisation and essential chronic medications. In-hospital specialist services are covered up to 100% of the DHR. These plans do not include day-to-day cover.
Smart Series
Smart plans offer cost-effective cover with network-restricted private hospital access and essential chronic benefits. They include limited day-to-day benefits, with in-hospital specialist cover ranging from 100% to 200% of the Discovery Health Rate (DHR), depending on the plan option.
KeyCare Series
KeyCare plans are designed for individuals seeking affordable medical cover with access to a network of healthcare providers. They provide essential benefits including hospitalisation at network facilities and cover for prescribed chronic conditions.
Each plan series is structured to cater to different patient healthcare needs and budgets.
TRA Gap Cover Policies
TRA’s four gap cover policies offer different levels of protection depending on individual circumstances and budget.
TRA’s Basic Cover 300
This policy suits members who may be on an entry-level or network-restricted plan. It includes up to 300% tariff cover, one specialist consultation shortfall per policy per annum, and a casualty unit benefit of up to R3,640 for accident-related events.
TRA’s Vital Cover Plus
This mid-tier policy offers up to 700% shortfall cover. It includes co-payment benefits up to R14,335 per policy per annum, plus dental support and oncology assistance. The casualty unit benefit increases to R9,700 for accidents.
TRA’s Super Cover Plus
This policy provides up to 700% tariff shortfall cover and supports multiple co-payment categories. Benefits include oncology new-tech treatment cover up to R9,040 per policy per annum, global fee shortfalls up to R13,230, and private ward cover for childbirth and non-childbirth admissions.
TRA’s Absolute Cover Plus
TRA’s most comprehensive product includes every benefit offered in the previous policies. Headline features include up to 700% tariff cover and extensive oncology support, plus breast reconstruction cover up to R38,588 for female cancer patients. It also covers prostheses sub-limit shortfalls up to R71,663 per event.
| TRA Policy | Premium Under 65 | Premium 65 and Over | Tariff Shortfall Cover |
| Basic Cover 300 | R99 individual / R197 family | R394 per policy | Up to 300% |
| Vital Cover Plus | R394 per policy | R591 per policy | Up to 700% |
| Super Cover Plus | R417 per policy | R626 per policy | Up to 700% |
| Absolute Cover Plus | R681 per policy | R846 per policy | Up to 700% |
How TRA Gap Cover Works
Gap cover is a supplementary insurance policy that adds financial protection to your existing medical aid membership. It is not a substitute for medical aid. Members must hold a registered medical aid scheme before signing up for gap cover.
What TRA Gap Cover Includes:
When you are admitted to hospital, medical aids like Discovery medical aid pay up to their scheme tariff unless stated otherwise per the plan. When the specialist or hospital charges more than that amount, TRA can help pay the difference. Depending on your plan, benefits may include:
- Tariff shortfalls on in-hospital services up to 700% above the medical aid tariff
- Co-payments for scopes and scans
- Co-payment cover for in-network and out-of-network oncology treatment
- Shortfalls for specialist consultations before in-hospital procedures
- Sub-limit gaps on prostheses up to R71,663 per event
- Authorised dental procedures performed in-hospital
- Oncology extender and new-tech treatment for Keytruda®, Yervoy®, Tagrisso® and Imbruvica®
- Casualty unit cover for accident-related visits
- Private ward cover up to R2,205 per day for three consecutive days
- Maternity follow-up consultations
- Accidental death benefit and policy continuation on the accidental passing of the main member
- Travel insurance for policyholders under the age of 71
- Access to TRA Assist services including Home Drive, trauma counselling and a 24/7 emergency line
All 2026 policies carry an aggregate annual limit of R219,845 per insured person, escalated annually by CPI.
TRA’s Approach to Waiting Periods
One of TRA’s stand-out features is the absence of a general three-month waiting period, and the usual 12-month prescribed waiting period for specific conditions is 10 months or under:
- 10-month waiting period for specific in-hospital procedures including scopes, joint replacements and childbirth
- 6-month pre-existing condition waiting period
- 9-month cancer waiting period when cancer was diagnosed before your policy start date
Members who had previous gap cover and sign up with TRA within 90 days may have waiting periods reduced or waived, subject to underwriter review.
Who Benefits from Gap Cover?
TRA gap cover can be worth it for Discovery Health Medical Scheme members across all ages and plans. You may benefit from gap cover when:
- You regularly visit specialists for planned in-hospital procedures
- You or a family member may one day undergo ongoing oncology treatment
- You are on a KeyCare, Saver or Core plan and want extra financial protection
- You want to avoid paying co-payments or tariff shortfalls from your own pocket
- You want a way to strengthen your medical aid protection without upgrading to a more expensive plan
Gap cover is a practical way to strengthen your healthcare cover in South Africa for families, retirees and young professionals alike.
Claims and Support
Submitting a claim with TRA is straightforward. You can:
- Use the online submission form on the website www.totalrisksa.co.za or on the mobile app
- Submit via email to claims@totalrisksa.co.za
- Contact the claims department directly
- Access TRA Assist with a 24/7 panic button and nurse advice via the TRA Assist app
TRA processes claims three times per week so payments reach you with minimal delay.
Get a Quote With TRA Gap Cover
Discovery offers trusted, flexible healthcare coverage across South Africa. With rising specialist costs and the complexity of in-hospital co-payments, additional protection has become more relevant than ever for many medical aid members. TRA’s gap cover plans pair with all Discovery plan series, from KeyCare to Executive.
Do not wait until a hospital stay reveals a costly shortfall. Get a quote today or sign up for Gap Cover with Total Risk Administrators.
Disclaimer:
This article was written on behalf of TRA and is intended to provide general information about how TRA Gap Cover can complement medical aid plans such as Discovery Medical Aid. It is not offering advice to its readers. TRA is an independent gap cover provider and is not affiliated with Discovery Medical Aid. All medical aid plan information referenced is based on publicly available sources as of 2025 and may be subject to change. For the most accurate and up-to-date details about your medical aid benefits, please consult directly with Discovery Medical Aid or visit their official website. Always review the full TRA policy documents to understand benefits, limitations, and waiting periods that may apply. TRA is underwritten by Auto&General, an authorised financial services provider and licensed non-life insurer.
