Medical aid and gap cover? They go together like socks and shoes or a bow and arrow. On their own, each serves a purpose. But together, they are the perfect match that can give you financial protection. The same could be true for Discovery Medical Aid members applying for TRA gap cover.
While Discovery offers a wide range of comprehensive medical aid options, many members are still surprised to learn that they will still need to pay out-of-pocket when their medical aid pays less than what healthcare providers charge.
These medical aid shortfalls are generally unavoidable when you have a medical scheme membership, because every medical scheme has predetermined tariffs that it will cover. If a specialist charges more, it isn’t in the medical aid’s control, nor will they adjust their coverage limits.
Total Risk Administrators’ (TRA) gap cover plans are specifically designed to bridge this gap, potentially supporting medical aid members by covering medical aid shortfalls, co-payments, and treatment costs that often arise during hospital stays or with specific out-of-hospital procedures.
Why Discovery Members May Choose TRA Gap Cover
Discovery Health Medical Scheme is one of South Africa’s most loved medical aid providers. This is mostly due to its suite of 23 health plan options that support different income levels and healthcare needs. While the level of hospital cover is strong across all plans, with no overall limits on most plans, patients are still responsible for any shortfalls when specialists charge above the medical aid tariff.
Gap Cover could help manage:
- Specialist charges that exceed what the medical aid pays
- Co-payments for in-hospital procedures and scans
- Cost differences for certain day clinic surgeries, scopes, and other scheduled treatments
- Oncology co-payments and sub-limit shortfalls during cancer treatment
- Unexpected medical payments not covered in full by the medical aid
Gap cover is especially valuable during hospital admissions, for high-cost treatments, or when using private healthcare providers.
Discovery’s Medical Aid Plan Structure
Discovery Health Medical Scheme offers a range of plans suited to various healthcare needs and budgets of South Africans. Here’s an overview of their plan structure:
Executive Plan
The Executive Plan provides comprehensive coverage, including unlimited private hospital access and extended chronic medicine benefits. It offers in-hospital specialist cover up to 300% of the Discovery Health Rate (DHR).
Comprehensive Series
These plans offer extensive in-hospital and day-to-day cover, with in-hospital specialist services covered up to 200% of the DHR. They include a Medical Savings Account (MSA) and an Above Threshold Benefit for additional day-to-day expenses once the MSA is depleted.
Priority Series
Priority plans provide a balance between comprehensive hospital cover and day-to-day benefits. They include an MSA and limited ATB, with in-hospital specialist cover up to 200% of the DHR.
Saver Series
Saver plans focus on in-hospital coverage with an MSA for day-to-day medical expenses. In-hospital specialist services are covered up to 200% of the DHR on Classic plans and up to 100% on Essential and Coastal plans.
Core Series
Core plans provide comprehensive medical coverage for hospitalisation and essential chronic medications, with in-hospital specialist services covered up to 100% of the DHR. These plans do not include day-to-day cover.
Smart Series
Smart plans offer cost-effective cover with network-restricted private hospital access and essential chronic benefits. They include limited day-to-day benefits and cover in-hospital specialist services up to 100% of the DHR.
KeyCare Series
KeyCare plans are designed for individuals seeking affordable medical cover, offering access to a network of healthcare providers. They provide essential benefits, including hospitalisation at network facilities and cover for prescribed chronic conditions.
Each of these plans is structured to cater to different patient healthcare needs and budgets.
TRA Gap Cover Policies
TRA’s range of gap cover policies offers members the opportunity to explore additional protection, depending on individual circumstances.
TRA’s Basic Cover 300
This policy is suitable for members who may be on an entry-level or network-restricted plan. This option includes up to 300% tariff cover, one specialist consultation(the shortfall), and a casualty unit benefit for accident-related events. It offers basic protection from common shortfalls.
TRA’s Vital Cover Plus
This policy offers mid-tier protection with up to 700% shortfall cover. It includes co-payment benefits, dental support, oncology assistance, and extended casualty benefits (for accidents). This can be helpful for those managing their own out-of-hospital spend while seeking enhanced hospital cover.
TRA’s Super Cover Plus
This policy also provides up to 700% tariff shortfall cover and supports multiple co-payment categories and specialist shortfalls. Additional benefits include oncology co-payments, new-tech treatment (e.g. Keytruda®, Imbruvica®), global fee shortfalls, and private ward cover.
TRA’s Absolute Cover Plus
TRA’s most comprehensive product includes every benefit offered in the previous policies. It features up to 700% tariff cover, extensive oncology support (including co-payments, extender benefits, and breast reconstruction for female cancer patients), maternity and private ward benefits, and high-cost support for prostheses, scans, and scopes.
How TRA Gap Cover Works
Gap cover is not a substitute for medical aid, it is a supplementary insurance policy that adds additional financial protection to your existing medical aid membership. Members must have a medical aid scheme before signing up for gap cover.
What TRA Gap Cover Includes:
When you’re admitted to the hospital or undergo a procedure, medical aids like Discovery medical aid pay up to their scheme tariff, unless otherwise stated per the plan. If the specialist or hospital charges more than that amount, TRA can help pay the difference. Depending on your plan, benefits may include:
- Tariff shortfalls on in-hospital services (up to 700% above the medical aid tariff)
- Co-payments for scopes, scans, oncology, and certain day clinic procedures
- Shortfalls for specialist consultations (including some out-of-hospital consultations related to certain in-hospital procedures)
- Sub-limit gaps on prostheses, scopes, and high-cost treatments
- Authorised dental procedures performed in-hospital
- Oncology extender benefits, including new-tech treatment support (e.g. Keytruda®, Yervoy®)
- Casualty unit cover for accident-related visits (adults and children)
- Private ward cover (childbirth and non-childbirth, within set daily limits)
- Maternity follow-up consultations
- Accidental death benefit and policy continuation on the passing of the main member due to an accident
- Travel insurance for policyholders under the age of 71
- Access to Home Drive, trauma counselling, nurse support, and a 24/7 emergency line via TRA Assist mobile app
Note: All gap cover policies are subject to an annual limit of R210,580 per insured person in 2025 (adjusted annually).
TRA’s Approach to Waiting Periods
One of TRA’s stand-out features is the absence of a general three-month waiting period, and the usual 12-month prescribed waiting period for specific conditions is 10 months or under:
- 10-month waiting period for specific in-hospital procedures, including scopes, joint replacements, spinal surgeries, and childbirth
- 6-month pre-existing condition waiting period 9-month cancer waiting period if cancer was diagnosed before your policy start date
- If you’ve had previous gap cover and sign up with TRA within 90 days, waiting periods may be reduced or waived, depending on your case.
Who Benefits from Gap Cover?
TRA gap cover can be worth it for Discovery Health Medical Scheme members across all ages and plans. You may benefit from gap cover if:
- You regularly visit specialists for planned in-hospital procedures
- You or a family member may one day undergo ongoing oncology treatment
- You’re on a key series, saver or core plan and want extra financial protection
- You want to avoid paying co-payments or tariff shortfalls from your own pocket
- You are looking for a way to improve your medical aid protection without upgrading to a more expensive plan
From families and retirees to young professionals, gap cover is a practical way to strengthen your healthcare cover in South Africa.
Claims and Support
Submitting a claim with TRA is simple. You can:
- Use the online portal or mobile app
- Submit via email
- Contact the claims department directly
- All policies include TRA Assist with a 24/7 panic button, nurse advice, and trauma line access
TRA processes claims three times per week, ensuring that you receive your payments quickly and with minimal hassle.
Get a Quote With TRA Gap Cover
Discovery offers trusted, flexible healthcare coverage across South Africa. But with rising costs, co-payments, and the complexity of in-hospital procedures and their coverage limits, having additional protection is more important than ever. TRA’s gap cover plans may be the perfect match for Discovery Medical Aid members, depending on individual healthcare needs.
Don’t wait until a hospital stay reveals a costly shortfall. Get a quote today or sign up for Gap Cover with Total Risk Administrators (TRA) today.
Disclaimer:
This article was written on behalf of TRA and is intended to provide general information about how TRA Gap Cover can complement medical aid plans such as Discovery Medical Aid. It is not offering advice to its readers. TRA is an independent gap cover provider and is not affiliated with Discovery Medical Aid. All medical aid plan information referenced is based on publicly available sources as of 2025 and may be subject to change. For the most accurate and up-to-date details about your medical aid benefits, please consult directly with Discovery Medical Aid or visit their official website. Always review the full TRA policy documents to understand benefits, limitations, and waiting periods that may apply. TRA is underwritten by Auto&General, an authorised financial services provider and licensed non-life insurer.
