Medical aid without gap cover? Just think of a train without tracks – you won’t get far. The same could be true for Bonitas Medical Aid and TRA Gap Cover. Gap cover complements medical aid, especially when facing unexpected hospital costs that fall outside of the medical scheme rates (MSR).
Even with the substantial benefits offered by Bonitas medical aid, members may still encounter co-payments or tariff shortfalls when doctors or hospital providers charge above the Bonitas rate.
That’s where gap cover insurance from providers like Total Risk Administrators (TRA) becomes essential for members looking for that additional financial protection.
Why Bonitas Members May Choose TRA Gap Cover
Bonitas is one of South Africa’s longest-standing medical aid providers, covering hundreds of thousands of members with a diverse range of benefit options. These range from entry-level hospital plans to more comprehensive cover with savings and preventative care benefits.
Even so, some costs may remain for the member to settle.
Gap cover could assist with:
- Specialist charges above the medical fund’s contracted rates
- Co-payments for procedures, oncology, or diagnostic scans
- Tariff shortfalls linked to high-cost procedures and prostheses
- Charges for authorised dental or maternity-related hospital stays
- Emergency visits for accidents to casualty units that are not fully covered by the plan
By providing shortfall support, gap cover may help to limit out-of-pocket payments during hospital admissions or advanced treatments.
Bonitas’ Medical Aid Plan Structure
Bonitas offers a range of plans structured to meet the needs of different household types, income brackets, and health priorities. Each plan has varying levels of hospital cover, preventative care, and specialist access:
BonStart & BonStart Plus
These hospital plans are aimed at younger, urban singles and young families, offering cost-effective access to care through network providers. Cover includes unlimited hospital access at designated network facilities, with restrictions based on income.
BonEssential & BonEssential Select
Provide unlimited hospital cover at any facility or within a network – up to the medical scheme rates. They include essential chronic care and maternity benefits, with no day-to-day benefits.
BonClassic & BonComplete
These plans offer more flexible provider choices and include both hospital cover and day-to-day benefits. Savings components help manage GP visits, medication, and basic dentistry. Co-payments and sub-limits apply for some procedures.
BonSave
It includes a set savings amount for out-of-hospital care, combined with full hospital cover and preventative screenings. It is often used by members who want to manage their own routine expenses.
BonFit Select
An income-based plan for younger individuals, with cover provided through a network of providers. This includes limited benefits for day-to-day care and unrestricted hospital coverage at selected facilities.
BonCap
A capitation-based option, offering coordinated care through selected providers. Members are assigned to a primary doctor and must follow referral protocols to access further services.
BonComprehensive
This is Bonitas’ most extensive option, with full hospital cover, high savings, and generous day-to-day limits. It also includes additional benefits for chronic care, maternity, and specialised procedures.
Across all plans, Bonitas medical aid members have access to the Bonitas app, where they can:
- View and update personal details
- Submit and track claims
- Access tax certificates, benefit balances, and hospital authorisation requests
- Locate network providers
TRA Gap Cover Policies
TRA offers four structured gap cover policy tiers, each with distinct benefits and features:
TRA’s Basic Cover 300
Basic Cover 300 includes up to 300% tariff shortfall cover, one annual specialist consultation shortfall, and casualty unit benefits for accident-related visits. It offers limited but targeted support.
TRA’s Vital Cover Plus
This policy offers up to 700% shortfall cover, along with co-payment benefits, basic oncology support, specified in-hospital dental procedure benefits, and extended casualty services.
TRA’s Super Cover Plus
This policy provides up to 700% cover, and includes benefits across multiple co-payment categories, global fee shortfalls, oncology support, and private ward cover.
TRA’s Absolute Cover Plus
Absolute Cover Plus, TRA’s most extensive product includes every benefit from the other tiers, as well as additional maternity support, oncology extender benefits, breast reconstructive treatment assistance, and high-cost prosthesis cover.
All policies give members access to the TRA Assist mobile app to access benefits, view coverage details, track claims, and download key documents.
How TRA Gap Cover Works
Gap cover works as a supplementary insurance policy. It does not replace your Bonitas medical aid, but may help manage shortfalls between what your scheme pays and what a provider charges.
What TRA Gap Cover Includes
When you’re admitted for a hospital procedure or need a scan or specialist, your Bonitas medical fund will pay up to a set tariff (the MST). If the specialist charges more than the medical scheme rate, the member will be liable for the difference. If members sign up for a gap cover policy with a provider like TRA, TRA may settle the difference within the annual cover limits*.
Depending on the policy selected, TRA’s gap cover benefits and coverage may include:
- Tariff shortfall cover on in-hospital procedures (up to 700%)
- Co-payments for oncology, scans, scopes, and certain day clinic procedures
- Specialist cover for consultations linked to hospital admissions
- Sub-limit benefits for prostheses and advanced diagnostics
- Authorised dental procedures performed in hospital
- Oncology extender benefits
- Casualty unit benefits (adults and children)
- Private ward cover, including for maternity stays
- Accidental death benefits and policy continuation for dependents
- International travel insurance (under age 71)
- Access to TRA Assist: trauma counselling, nurse support, and 24/7 help
Note: *All gap cover policies are subject to an annual limit of R210,580 per insured person currently in 2025 (adjusted annually, effective back to 1 April every year).
TRA’s Approach to Waiting Periods
TRA does not apply a blanket three-month waiting period. Specific timelines are:
- 10 months for scopes, joint replacements, spinal surgery, and childbirth etc.
- 6 months for pre-existing conditions
- 9 months for cancer, diagnosed before the policy start date
Where a member moves from another gap cover provider within 90 days, waiting periods may be adjusted depending on the case.
Who Benefits from Gap Cover?
TRA Gap could be worth it to Bonitas members who experience:
- Specialist care exceeding scheme tariffs
- Out-of-pocket payments during hospital admissions
- Co-payments on oncology or day procedures
- Planned surgeries or specialist-led treatments
- Emergency visits that are not fully covered
Whether managing a household, preparing for surgery, or seeking predictable benefits, gap cover may offer additional support for members across Bonitas’s full benefit option range.
Claims and Support
TRA offers straightforward claim processes:
- Use the website or TRA mobile app
- Email claims directly to the TRA claims team
TRA processes claims three times per week to help ensure efficient turnaround.
Get a Quote With TRA Gap Cover
Bonitas medical aid offers flexible benefit options, broad hospital cover, and useful preventative care benefits. Still, there may be instances where additional support becomes necessary, especially when facing co-payments, shortfalls, or advanced procedures. TRA may be the perfect match for Bonitas Medical Aid members seeking additional cover.
Be prepared, ensure the gap is covered. Get a quote or sign up for Gap Cover today with Total Risk Administrators (TRA)
Disclaimer:
This article was written on behalf of TRA and is intended to provide general information about how TRA Gap Cover may support medical aid members. It does not constitute financial advice. TRA is not affiliated with Bonitas. All Bonitas medical fund plan information was sourced from publicly available content as of 2025 and may change. Please consult Bonitas directly for the latest plan information. Always review the full TRA policy documentation for cover specifics, limitations, and waiting periods. TRA is underwritten by Auto&General Insurance Company Limited, an authorised financial services provider and licensed non-life insurer.
