Some things just work better together, like a needle and thread or a lock and key. The same could be true for Medshield Medical Aid and TRA Gap Cover. When combined, medical aid and gap cover can work to ensure your healthcare cover is complete, with no expensive gaps left behind.
If you’re on Medshield Medical Aid and want added protection from unexpected hospital bills, gap cover could be the answer. Medshield offers a range of flexible medical aid plans; however, members are still responsible for paying the difference when healthcare providers charge more than the medical aid pays.
Total Risk Administrator’s (TRA’s) gap cover policies are designed to help medical aid members manage these shortfalls, covering co-payments, tariff gaps, and expenses that arise during in-hospital procedures or related specialist consultations.
With a wide range of gap cover options and no general waiting period, TRA is a trusted partner in your healthcare protection.
Why Medshield Members May Choose TRA Gap Cover
As a registered medical aid scheme, Medshield supports families, professionals, and individuals with carefully designed medical scheme options. These plans range from network-based affordability to high-end hospitals of your choice. But even with unlimited hospital cover, Medshield members can still face out-of-pocket costs when fees exceed the scheme tariff.
Gap Cover could help manage:
- Tariff shortfalls for specialists, surgeons, and anaesthetists
- Co-payments for authorised procedures, scans, and scopes
- Sub-limit shortfalls on prostheses, oncology, and scopes
- Prescribed minimum benefits that aren’t fully covered
- Added cover for private ward use and maternity follow-ups
Gap cover becomes especially useful during hospital admissions, cancer treatment, or when using private healthcare providers outside a network.
Medshield’s Medical Aid Plan Structure
Medshield offers a range of medical aid plans tailored to suit different life stages, health needs, and budgets. From entry-level cover to premium benefits, members can choose a plan that aligns with their healthcare priorities.
PremiumPlus and MediBonus
These top-tier options provide access to private hospitals and extend in-hospital cover up to 200% of the Medshield Private Tariff. They are well-suited to individuals and families seeking broader medical protection, with comprehensive cover for hospital admissions, specialist consultations, and chronic care benefits.
MediPlus and MediSaver
Balanced plans like these are designed for families or individuals who want a mix of in-hospital cover and structured day-to-day benefits. These plans offer good protection for medical events while also supporting general healthcare needs like GP visits, prescribed medication, and routine tests.
MediCore and MediValue
Hospital-focused plans that offer essential cover for major medical events. These options are ideal for members who prefer to manage their own out-of-hospital expenses but still want reliable protection for hospitalisation, surgery, and emergencies.
MediCurve and MediPhila
Entry-level options are designed for younger, healthier individuals or those with limited budgets. These plans offer essential hospital cover through network providers and are designed to keep premiums affordable while still providing access to essential healthcare services.
TRA’s Gap Cover Policies
TRA’s range of gap cover policies is designed to provide options that can help medical aid members manage shortfalls, co-payments, and higher-cost procedures without necessarily upgrading to a more expensive medical aid plan.
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. 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 a supplementary insurance policy that supports your existing medical scheme. It doesn’t replace your medical aid membership but rather strengthens it. Members must have a medical aid scheme before signing up for gap cover.
What TRA Gap Cover Includes:
When you’re hospitalised or need a covered procedure, like most medical aids, Medshield pays up to its scheme tariff. If the hospital or specialist charges more, TRA can step in to cover the difference. Depending on your chosen 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 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 viathe 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).
Waiting Periods to Note
TRA does not apply a general 3-month waiting period in most claims cases, but some specific-condition waiting periods do apply:
- 10-month condition-specific waiting period (e.g. childbirth, scopes, spinal surgery, joint replacements)
- 9-month cancer waiting period, unless in remission for 2+ years
- 6-month pre-existing condition waiting period
If you’ve had previous gap cover and switch to TRA within 90 days, waiting periods may be waived or shortened (on a case-by-case basis).
Who Should Consider TRA Gap Cover?
TRA gap cover could add value across all Medshield Medical Aid’s plans. It’s beneficial if:
- You see specialists or need regular in-hospital treatment
- You may (one day) undergo cancer treatment or major surgery (even due to an accident)
- You’re on a plan with networks or savings limits
- You want to avoid paying out-of-pocket for co-payments or tariff shortfalls
- You’re looking for peace of mind without upgrading to a more expensive medical aid
Submitting Claims and Getting Support
TRA makes the claims process simple:
- With Medshield Medical Aid, TRA automatically receives gap shortfall claims directly from this medical aid
- Therefore, if you are a member of Medshield Medical Aid and TRA gap cover, the Policyholder doesn’t need to submit their claim to TRA. TRA will receive an electronic version of the claim and will process said claims within seven (7) working days of receipt thereof.
- Only co-payment and sub-limit claims need to be submitted manually to TRA.
- Manual claims can be submitted via the TRA mobile app, email, or website
- Claims are processed three times per week
- Support is available via phone or digital platforms
- All policies include TRA Assist with a 24/7 panic button, nurse advice, and trauma line access
Get a TRA Gap Cover Quote
If you’re a Medshield member looking to improve your healthcare protection, TRA may offer the perfect gap cover policy to match your medical aid plan, depending on individual healthcare needs.
TRA ensures that medical aid members in South Africa are never left to cover major shortfall expenses on their own.
Protect the difference. Get a quote or sign up for Gap Cover with Total Risk Administrators (TRA) today.
Disclaimer:
This article is written on behalf of TRA and is intended to provide general information about how TRA Gap Cover can complement medical aid plans such as Medshield Medical Aid. It is not offering advice to its readers. TRA is an independent gap cover provider and is not affiliated with Medshield 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 Medshield 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.
