You qualify for gap cover in South Africa when you are a registered member of a medical aid scheme. Gap cover sits alongside your medical aid and pays the in-hospital shortfalls that arise when specialists charge more than the scheme’s tariff. You can extend the policy to your spouse and dependants who share your medical aid membership.
Now that we’ve covered one of the most frequent questions we receive as a trusted gap cover provider in South Africa, let’s dive in deeper to break it down a little bit further.
Do I Qualify For Gap Cover?
Just about anyone is eligible for gap cover if you are, first and foremost, a member of a registered South African medical aid scheme. With this, you can cover your spouse and other dependants (up to a certain age), provided that your family also belongs to your medical aid scheme.
Gap cover pays the shortfall on approved in-hospital claims that your medical aid has processed. The claim must relate to an authorised hospital admission for the gap cover to pay.
Qualifying for Gap Cover: Waiting Periods and Exclusions
Waiting periods are the months after sign-up during which certain claims are not yet payable. Understanding them upfront sets the expectation for when full cover kicks in.
Industry waiting periods on gap cover typically work as follows. New members often face a 3-month general waiting period before any benefits become payable. Members with pre-existing conditions may be held off for up to 12 months on claims related to that condition. These terms vary by provider.
TRA Gap Cover Waiting Periods
At Total Risk Administrators (TRA), there is no general three-month waiting period on new policies. Members who can show proof of previous gap cover on an active membership within 90 days before sign-up may have their pre-existing condition waiting periods reduced or waived, subject to underwriter review.
If needed, we will gladly provide more information and a comprehensive breakdown of TRA’s waiting periods to ensure that you get the full picture before deciding on which option might be best suited to you and your personal needs.
The table below sets out TRA’s 2026 waiting periods for new members:
| Waiting Period | TRA’s 2026 Terms |
| General waiting period | None |
| Pre-existing conditions | 6 months |
| Condition specific procedures (scopes, joint replacement, childbirth and similar) | 10 months |
| Cancer diagnosed before policy start | 9 months |
| Transfer from previous gap cover within 90 days | Reduced or waived |
For a full breakdown of which conditions sit under the 10-month list, see TRA’s gap cover product pages.
What Counts as an Exclusion
So what exactly is an exclusion? An exclusion is a procedure or treatment that your gap cover does not pay for at all. Common gap cover exclusions include cosmetic surgery and certain dental procedures. Reading the fine print on any policy is the only way to know what is and isn’t covered before you sign up.
A gap cover provider can also decline a claim where you have not complied with your medical aid’s authorisation procedures. Failing to get pre-authorisation from your medical aid scheme is the most common cause of declined claims.
What Happens In The Case of a Foreigner?
Non-South African citizens planning to stay in the country long-term can join most medical aid schemes, provided premiums are paid from a South African bank account. The account does not have to belong to the foreigner personally; it just needs to be a valid local funding source.
A valid passport and current visa are the documentary requirements. Foreigners on a South African medical aid scheme then receive the same benefits as South African members.
Holidaymakers visiting South Africa cannot join a medical aid for short stays. For short-term cover, travel insurance is the appropriate product.
As a non-South African making use of a medical aid scheme in South Africa, you will have the same medical aid benefits as a South African would in ensuring you are covered.
Contact a registered medical aid advisor for personalised guidance on medical aid coverage as a non-citizen.
Medical Gap Cover Questions and Queries
Comparing medical aid and gap cover options can become overwhelming once you factor in plan terms, waiting periods and exclusions. TRA’s team can help you work through the options to find the plan that fits your circumstances.
If you have any more queries or questions regarding anything related to TRA gap cover, explore our website for more information or get in touch with us today.
For more on TRA’s gap cover plans or to ask a specific question, get in touch with TRA or get a quote today.
Note: All material on this website is provided for your information only and may not be construed as medical advice, general advice, or instruction of any kind. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals and/or intermediaries, or other relevant professionals, on any matter relating to their health and overall well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors at the time, and readers who fail to consult with appropriate health and/or financial authorities etc. assume the risk of any injuries and/or liabilities etc. Please note that Gap Cover is not a medical aid, and it is not a substitute for medical aid. Errors and Omissions Excepted. Terms and Conditions Apply.
