Almost anyone can qualify for gap cover but you have to have a medical aid in place. You cannot get a gap cover plan without a medical aid plan. Now that we’ve covered that question – let’s just break it down a little bit further.

Who is eligible for gap cover?

Anyone is eligible for gap cover if you are a member of a registered South African medical aid scheme. You can cover your spouse and dependants (up till a certain age), provided that your family belongs to your medical aid scheme.

Gap cover will cover those in-hospital shortfalls but you have to have approved in-hospital claims that are related to your hospital submission.

What are the general exclusions or waiting periods?

Not all covers come into effect straight away and you will hear the term “waiting period” – but what does that mean? Are you still covered if something happens within that waiting period?

As with your medical aid, waiting periods and exclusions also apply to gap cover. There is usually a 3 month waiting period to be able to have all the benefits. If you have a pre-existing condition you may be expected to wait 12 months and during those waiting periods you are not eligible for 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, with active membership not longer than 90 days prior, the pre-existing condition waiting periods may be reduced or waived.

For more information and a comprehensive breakdown of TRA’s waiting periods, please click here.

What is an exclusion? This is for certain procedures and or treatments that are not covered by your gap cover benefit which include things like cosmetic surgery or certain dental procedures (please read the fine print when applying for a gap cover). Gap cover 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’re 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 Afarican bank account to pay for the cover, even if the account doesn’t belong to that foreigner. Provided that you have a valid passport and hold a current Visa. However if you are a holiday maker you would need to rely on travel insurance should you find yourself in a medical pickle.

As a non South African making use of medical aid – you will have the same medical aid benefits as a South African would.

Chat to a medical aid advisor if you are a South African or even a non-South African and find out more about medical aid covers.

Medical Gap Cover Questions & Queries

If you have any more queries or questions regarding anything related to TRA Gap Cover, why not reach out to our helpful specialists here. You can also visit our Gap Cover page here.


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