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Qualifying For Gap Cover: All You Need To Know

Qualifying For Gap Cover: All You Need To Know

Today more than ever, with the wide range of medical aid schemes and gap cover providers, just about everyone can have some form of medical coverage in place. And whilst almost anyone can qualify for gap cover, you do have to have to be a member of a medical aid scheme in place to be covered by gap cover.

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 dependents (up to a certain age), provided that your family also belongs to your medical aid scheme.

Having gap cover will ensure that those in-hospital shortfalls are covered; however, you must have approved in-hospital claims related to your hospital submission.

What Are The General Exclusions or Waiting Periods?

When looking at getting gap cover, it must be known that not all covers come into effect straight away. When navigating the world of gap cover, you will frequently hear the term “waiting period”, and understanding this makes things easier for everyone from the get-go. So what exactly does this term entail? And are you still covered if something happens within that waiting period?

As with just about every medical aid scheme, waiting periods and exclusions also apply to gap cover plans. There is usually a 3-month waiting period that a new member will be under in order to be eligible to enjoy all the gap cover benefits. If you have a pre-existing condition, you may be expected to wait 12 months, during which you are, in fact, not eligible for cover in something were to happen that would need to be covered.

TRA Gap Cover

At Total Risk Administrators, we have tailored our gap cover to have no general three-month waiting period. And, if you can provide proof of a pre-existing medical expense shortfall policy alongside an active membership not longer than 90 days prior, the pre-existing condition waiting periods may be reduced or waived.

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.

So what exactly is an exclusion? This is applicable to specific procedures or treatments that are not covered by your gap cover benefit. This can include procedures like cosmetic surgery or certain dental procedures. With this, the importance of reading the fine print when applying for a gap cover could not be further emphasised. It must be noted that a gap cover provider also reserves the right to refuse to cover you due to non-compliance with your medical aid scheme rules or authorisation procedures.

What Happens In The Case of a Foreigner?

If you are a non-South African citizen and you plan to stay in the country for a long period of time, most medical aid schemes will allow you to join as long as there is a South African bank account that is able to pay for the cover. This is applicable even if the account doesn’t belong to that foreigner themself but still exists as a source of funds to cover the monthly costs of medical coverage.

Provided that you have a valid passport and hold a current visa to be in South Africa, you, as a foreigner, can access medical coverage when it is needed most. However, in the case of an individual being a holidaymaker in South Africa, you would need to rely on having travel insurance in place should you find yourself in an unforeseen circumstance that involves medical costs coming into play.

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.

It is advised to contact a medical aid advisor, whether you are a South African citizen or even a non-South African, to learn more about medical aid coverage and how best to navigate it all.

Medical Gap Cover Questions & Queries

With comparing and applying for the various options of medical aid or gap cover available today, it can become overwhelming to take into account all the information, terms and conditions that may apply. We can help you understand it all to be better equipped to make the best possible decision for yourself.

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.


Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on and matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.


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