Some things go hand in hand, like a violin and its bow. The same could be said of BestMed Medical Aid and TRA Gap Cover. When paired together, a medical aid scheme and gap cover policy can provide more complete financial protection for your healthcare needs, helping you avoid unexpected shortfalls – music to your ears, right?
If you’re a BestMed member, gap cover can help cover the gap between what your medical scheme pays and what private healthcare providers charge. Even with BestMed’s extensive hospital and chronic benefits, you may still encounter costs that aren’t fully covered, especially during in-hospital procedures or specialist consultations.
Total Risk Administrators (TRA) offers a selection of medical gap cover policies designed to potentially support BestMed members by covering these differences. Whether it’s co-payments, specialist shortfalls, or tariff gaps, TRA’s range of plans can provide cover tailored to support your current medical aid within your budget.
Why BestMed Members May Choose TRA Gap Cover
BestMed is one of South Africa’s largest self-administered healthcare schemes, offering a personal approach to healthcare. From entry-level network options to fully comprehensive plan ranges, BestMed caters to individuals, families, and retirees with varied healthcare needs.
However, even with their hospital benefits and access to designated service providers, members may face out-of-pocket expenses for certain procedures, scans, or specialist fees. This is where gap cover becomes valuable.
Gap cover can help manage:
- Tariff shortfalls on services from anaesthetists, surgeons, or specialists
- Co-payments for authorised in-hospital procedures and diagnostic scans
- Shortfalls in prostheses, oncology treatment, and scopes
- In-hospital dental treatment that is not fully covered by the medical aid
- Cover for private ward use and maternity follow-ups
- Prescribed Minimum Benefits (PMBs) that don’t cover the whole bill
Gap cover is beneficial for planned surgeries, cancer treatment, or any care involving private healthcare providers that charge above the BestMed scheme rate.
BestMed’s Medical Aid Plan Structure
BestMed offers three primary product categories – Rhythm, Beat, and Pace – designed to match different lifestyles, health profiles, and financial needs.
Pace Range
The Pace range offers fully comprehensive benefits with extended in-hospital and day-to-day cover. Plans like Pace2, Pace3, and Pace4 include private hospital access, chronic medication, and specialist consultation allowances. Ideal for families or individuals seeking the highest level of protection, Pace plans also include maternity and preventative care benefits.
Beat Range
Beat plans offer a balanced approach, with structured savings accounts or network options. Beat1 to Beat4 provide solid hospital cover with varying levels of day-to-day support. These plans are well-suited for families and individuals who want hospital cover with more flexibility in GP visits, scans, and medication.
Rhythm Range
Rhythm1 and Rhythm2 are income-based plans designed to be more affordable with access to core services through a managed provider network. While hospital care is unlimited at designated hospitals for PMBs, there are still co-payments and tariff differences that may leave members exposed to medical shortfalls.
Across all options, BestMed members are encouraged to obtain pre-authorisation for planned procedures and to understand when co-payments may apply.
TRA’s Gap Cover Policies
TRA offers four gap cover policies that can help BestMed members manage their hospital expenses more effectively, without needing to upgrade to a higher-cost plan.
Basic Cover 300
Ideal for entry-level workers or members on network or entry-level plans, as this is a cost-effective product that protects some of the most common shortfalls.
- Up to 300% tariff shortfall cover
- Casualty unit benefit for accidental injuries
- One specialist consultation shortfall per year
Vital Cover Plus
This plan helps manage hospital-related costs for members with moderate day-to-day and in-hospital usage.
- Up to 700% shortfall cover
- Co-payment cover for scopes and scans
- Limited oncology support
- Dental shortfall cover for in-hospital treatment
Super Cover Plus
Offering support for more comprehensive medical aid plans with additional cover for oncology and specific scans.
- 700% tariff gap cover
- Co-payments across multiple procedure categories
- Oncology co-payment benefits
- Specialist shortfalls and global fee cover
- Support for new-tech cancer treatments
Absolute Cover Plus
TRA’s most comprehensive product, which includes all that Super Cover Plus offers, with access to emergency medical services like ambulances.
- Up to 700% tariff shortfall cover
- Oncology and maternity benefits
- Extended prosthesis and scope shortfall protection
- Cover for high-cost treatments and private ward stays
- Additional trauma, accident, and emergency benefits
How TRA Gap Cover Works
Gap cover is not a replacement for medical aid; it is a complementary insurance policy designed to support your current medical aid by covering shortfalls during authorised procedures and treatments. It is important to note that a member must be part of a medical aid scheme in order to qualify for gap cover.
When you’re admitted to the hospital, BestMed pays up to its scheme tariff. However, specialists or surgeons may charge above that rate. TRA gap cover can help pay the difference, depending on the policy you’ve selected.
Depending On Your Plan, TRA Gap Cover Benefits Include:
- Specialist and surgeon shortfalls (up to 700%)
- Co-payments for scopes, oncology, and day clinic procedures
- Sub-limit gaps on prostheses, scopes, and other treatments
- In-hospital dental treatments
- Maternity consultations and private ward stays
- Oncology support and cover for advanced treatments
- Accidental casualty visits for adults and children
- Accidental death cover and continuation of policy for family members
- Access to the TRA Assist app for nurse support, trauma counselling, and 24/7 emergency services
Note: The annual limit for all TRA gap cover claims in 2025 is R210,580 per insured individual (adjusted annually).
Waiting Periods to Consider
TRA does not apply a general 3-month waiting period for most claims, but some waiting periods do apply:
- 10-month condition-specific waiting period (e.g. childbirth, spinal surgery, scopes)
- 9-month oncology waiting period unless the condition has been in remission for 2 or more years
- 6-month pre-existing condition waiting period
If you move to TRA from another gap provider within 90 days, certain waiting periods may be reduced or waived depending on your previous cover.
Who Should Consider TRA Gap Cover?
Gap cover can benefit all types of medical aid members. You may want to consider adding TRA gap cover if:
- You regularly see specialists or plan elective surgeries
- You want to avoid surprise medical bills during hospitalisation
- You’re concerned about covering cancer-related costs
- Your medical aid plan includes co-payments or limited specialist coverage
- You’d like peace of mind without upgrading to a more expensive medical aid option
Submitting Claims and Getting Support
TRA works directly with BestMed Medical Aid for most shortfall claims. This means:
- TRA automatically receives electronic shortfall claims from BestMed
- No need for you to submit claims manually (unless it’s a co-payment or sub-limit claim)
- Manual claims can be submitted via the TRA app, email, or website
- Claims are processed three times per week
- Policyholders have access to various 24/7 support via the TRA Assist app
Get a TRA Gap Cover Quote
If you’re a BestMed member looking to reduce medical shortfalls and protect yourself from unexpected hospital expenses, TRA offers tailored gap cover options that can support your medical aid benefits.
Make sure your cover works in complete harmony. Get a quote or sign up for TRA Gap Cover today and let your BestMed medical aid and gap cover work together like the perfect pair.
Disclaimer:
This article is written on behalf of TRA and is intended to provide general information about how TRA Gap Cover complements medical aid plans like BestMed Medical Aid. TRA is an independent gap cover provider and is not affiliated with BestMed Medical Scheme. All BestMed plan details are based on the 2025 public comparison brochure and may be subject to change. For up-to-date benefit information, consult directly with BestMed or visit their official website. Always read your full TRA policy document to understand all benefits, limits, and waiting periods. TRA is underwritten by Auto&General, a licensed non-life insurer and authorised FSP.
