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Gap Cover FAQs by Total Risk Administrators

Gap Cover FAQs by Gappy

Welcome to TRA’s Gap Cover FAQ Article.

Here, we have compiled comprehensive answers to some of the most commonly asked questions about gap cover in South Africa, helping you understand how this product can protect you against unforeseen medical costs. 

What is Medical Aid Gap Cover in South Africa?

In South Africa, gap cover is a type of supplementary insurance that helps bridge the gap between what healthcare providers charge and what your medial aid will pay. By working alongside your existing medical aid scheme, gap cover provides additional coverage for certain medical expenses that exceed the base tariff rates covered by your medical aid. This means you can have peace of mind knowing you have extra protection against unexpected medical costs.

Don’t be misled. Gap cover is not a substitute for medical aid or a medical replacement but a separate product. This coverage is crucial in managing costs during hospital stays, specific medical procedures, and in-hospital specialist consultations not fully covered by standard medical aids.

Does Gap Cover Pay for In-Hospital Expenses?

Typically, gap coverage providers cover in-hospital expenses. However, only certain providers cover specific out-of-hospital procedures. Total Risk Administrators (TRA) are providers covering specified procedures both in and out of the hospital.

TRA’s Gap Cover includes:

  • The shortfall for in-hospital procedures where specialists might charge several times the base medical aid rate.
  • Out-patient treatments that involve certain medical procedures.
  • Specific oncology benefits, covering the discrepancy between oncologist charges and medical aid limits.
  • Medical aid schemes for various treatments require co-payments and specific sub-limits.
  • Cover for financial protection against medical expense shortfalls, including co-payments, maternity shortfalls, in-hospital,  specialist consultations, treatment and procedures, internal prostheses, and casualty costs.

See our 2024 Brochure

What is an Access Gap Cover?

Also known simply as Gap Cover, Access Gap Cover aims to reduce or completely eliminate insured individuals’ out-of-pocket expenses by forming agreements with healthcare providers. These agreements cap the charges for services at a level that ensures minimal personal spending, enhancing the affordability of medical treatments under your policy.

Which Gap Cover Is The Best?

When selecting the most suitable gap cover, opting for a plan that offers comprehensive coverage and flexibility to cater to various medical requirements is crucial.

Total Risk Administrators recommends an ideal gap cover plan that should provide benefits beyond the basic medical aid tariffs, covering up to 700% of those rates. The most exceptional plans, such as those offered by TRA, will include additional benefits that cover oncology treatments, co-payments, sub-limits, and casualty visits. These features are essential for comprehensive protection and make Total Risk Administrators’ offerings among the best available.

Who Offers The Best Gap Cover in South Africa?

Total Risk Administrators (TRA) is known for providing the best gap cover in South Africa. Our plans stand out because they exceed client expectations regarding coverage and service.

See our article highlighting how we were ranked “Top Gap Cover Provider” on Hellopeter.

At Total Risk Administrators, we provide exceptional customer service and customised gap cover options that cater to individuals’ unique financial and medical challenges. Our approach to gap cover involves gaining a detailed understanding of client requirements. We ensure that our products provide significant value and protection against the high costs of medical care in South Africa. Our commitment to quality and client satisfaction makes us a leading provider in the gap cover market.

Can Gap Cover be Claimed for Tax?

In South Africa, you cannot claim the premiums paid towards gap cover as a deduction in your tax returns. This means the amount you pay for your gap cover insurance is not tax-deductible. However, if you receive payouts from your gap cover, discussing the specifics with a tax advisor is necessary, as this could impact your tax obligations under certain circumstances.

How Does Gap Cover Work?

Gap cover covers the difference between what your healthcare provider charges and your medical aid pays. This kind of insurance is essential for covering the “gap” during medical treatments like surgeries or hospital stays where the medical provider’s fees are higher than what your medical aid covers. Once your medical aid has processed and paid their portion of the bill, you can claim the remaining amount from your gap cover provider, according to the terms of your policy. It’s important to note that gap cover doesn’t replace medical aid but serves as supplementary insurance to your existing medical aid plan.

Total Risk Administrators offer different gap cover options, including Basic Cover 300, Vital Cover Plus, Super Cover Plus, and Absolute Cover Plus. These plans provide varying levels of coverage, ranging from 300% to 700% of the medical aid tariff.

How Much Does Gap Cover Cost?

The cost of gap cover varies depending on several factors, such as the provider, the level of coverage provided, the age of the beneficiaries, and the specific benefits included in the plan. Generally, gap cover premiums can range from a few hundred rand per month to higher amounts based on the comprehensiveness of the cover.

At Total Risk Administrators, we offer gap cover plans with affordable and competitive pricing. Our premium rates begin at R99 monthly for basic individual coverage and increase based on the plan and coverage level chosen. This pricing structure is designed to help you find a plan that fits your budget and coverage needs, whether you are an individual or a family.

How Much is Gap Cover in South Africa?

In South Africa, the pricing for gap cover generally ranges between R100 and R600 per month. This range is influenced by the type of plan, the benefits included, and the insurance provider.

Total Risk Administrators provide a detailed overview of our gap cover plans, with prices reflecting the level of coverage provided. Our plans offer protection against medical treatment shortfalls, with specific benefits tailored to effectively cover both in-hospital and certain out-of-hospital procedures.

See our pricing.

Gap Cover When Already Pregnant?

In South Africa, if you are already pregnant and considering gap cover, it’s crucial to understand that many insurers will have specific waiting periods for maternity-related claims. If you take out a gap cover policy after becoming pregnant, the expenses related to the pregnancy and childbirth might not be covered if the childbirth occurs during the waiting period stipulated by the provider.

Total Risk Administrators’ gap cover includes specific terms for pregnancy. We offer a maternity benefit, but there is a waiting period of 10 months before it becomes effective. This means that expenses related to childbirth are only covered if the gap cover has been active for at least 10 months before the birth. This policy ensures members have adequate coverage when needed, provided they plan and get covered before becoming pregnant. However, if you are already pregnant, you can apply for your child to be on our policies, which will help cover the shortfall of in-hospital fees after childbirth.

Why Gap Cover?

This type of cover is particularly valuable in scenarios involving high-cost medical care, such as surgeries, specialised treatments, or unexpected medical emergencies, where the financial burden can be significant.

Total Risk Administrators emphasise that gap cover is worth it as it provides financial security and peace of mind. Our gap cover plans are designed to mitigate the financial risks associated with medical treatment costs not fully covered by medical aids. By offering up to 700% of the tariff rates and covering additional expenses such as co-payments and sub-limits, TRA’s gap cover ensures that individuals and families are not left financially vulnerable during critical times of medical need.

Learn more about TRAs coverage on our website

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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