Medical aids and medical schemes in South Africa don’t cover the full cost of healthcare. The gap between what medical aid pays and what healthcare providers charge creates significant financial risk for employees. Corporate gap cover bridges this gap, protecting your workforce from unexpected medical costs and debt.
What Is Corporate Gap Cover?
Corporate gap cover is a group insurance policy that covers the difference between medical scheme tariff rates and what healthcare providers actually charge. When healthcare providers may charge 200% to 700% above scheme rates, gap cover pays the shortfall.
Without this protection, employees face bills reaching tens of thousands of rands after hospital admissions, surgeries, or cancer treatment, even with medical aid coverage.
Financial Impact Example
Here’s a recent case study for a Pregnancy shortfall in 2025:
| Total Medical Bill | Monthly Medical Aid Premiums (2x Adults) | Amount Paid by Medical Aid | Shortfall Amount Covered by Gap Cover | Gap Cover Premium (TRA’s Absolute Plus) | Amount Owed by Patient |
| R90,562.55 | R6 652p/m | R51,514.23 | R38,309.30 | R620p/m | R0 |
Without gap cover, these shortfalls become out-of-pocket expenses that can devastate your finances.
These medical costs become immediate debt without gap cover, creating financial stress that impacts workplace performance and well-being.
Why Employer Groups Choose Gap Cover with Medical Aid
- Attract and retain talent with a benefit that provides real financial protection across all age groups
- Reduce absenteeism by eliminating financial barriers to quality healthcare and specialist treatment
- Comprehensive cancer protection with oncology gap benefits and co-payment cover when medical aid limits are exhausted
- Family-wide peace of mind covering employees, spouse, and dependents on the medical scheme policy
TRA Corporate Gap Cover: 90,000+ Lives Protected
Total Risk Administrators (TRA) delivers corporate gap cover solutions for employer groups, medical scheme administrators, and professional associations nationwide.
All benefits subject to terms, conditions, and waiting periods. Absolute Cover Plus coverage shown below.
| Benefit Category | Coverage Details |
| In-Hospital Procedures | • 700% above medical scheme tariff coverage• Theatre, ward, and equipment shortfalls: R5,000 (Absolute Cover Plus)• Covers gaps where healthcare providers charge above what medical aid pays |
| Co-Payments Coverage | • Unlimited in-network co-payments (subject to R219,845 aggregate annual limit)• Out-of-network: 2 co-payments up to R16,800• MRI/CT/PET scan co-payments covered – 2 scans per policy per annum |
| Emergency Care | • Casualty benefit: R23,100 per policy per annum• Unlimited ambulance coverage (subject to aggregate annual limit) • 24/7 trauma counselling via TRA Assist |
| Oncology Protection | • Gap benefit for cancer treatment shortfalls• Unlimited(subject to the R219 845 limit) in-network oncology co-payment cover• Extender benefit when your medical scheme annual limits are exhausted• Breast reconstruction: R36,750 per beneficiary per life of policy• New-tech oncology medications covered up to R17 325 per policy per annum |
| Pregnancy & Maternity | • Childbirth shortfall coverage• Maternity Follow-Up Consultations Cover for Shortfall on a specialist: R1,250 per consultation per policy, per annum• Private ward shortfall benefit: R2,100/day for 3 days |
| Specialist Services | • Sub-Limits on MRI/CT/PET scans: 2 scans at R6,300 each• Specialist consultations: Shortfall is covered on a specialist account related to the consultation in the rooms before a member goes for an in-hospital procedure.• Internal prostheses sub-limits: R68,250 per event• Global fee benefit: R25,200 for robotic surgery |
Examples of Implementation Options for Employer Groups
Employer-Paid: Full premium coverage as a core benefit
Cost-Sharing: Employer subsidises 50-75%, employees contribute via payroll
Voluntary: Group premiums with employee opt-in and salary deduction
Tiered: Different plans by seniority with voluntary upgrades
Who Qualifies?
Employees must be members of a registered medical scheme or medical aid. Coverage extends to spouse and dependents. No age limits apply. Waiting periods may apply to specific conditions (In some cases, if an employer group joins TRA gap cover as a larger group, all the standard waiting periods may be waived)
Some of the Exclusions: Cosmetic surgery (unless for certain oncology benefits), procedures not authorised by medical aid, and routine GP visits.
Get Started Today With TRA
Apply online for instant quotes. Contact TRA to discuss your employer group’s needs, review the policy brochure, and implement gap cover that protects employees from rising medical costs.
Medical scheme members deserve protection from the gaps that medical aid leaves. TRA’s corporate gap cover delivers peace of mind and financial security when your people need it most.
Apply Online: www.totalrisksa.co.za
We have also created a corporate-specific page, where you can get a corporate-specific quote based on your needs and wants. Click here for more information.
