As Josh Billings once said, “Health is like money. We never have a true idea of its value until we lose it.” For South Africans navigating rising medical costs, gap cover short-term insurance is an important consideration for anyone who values their health and financial security.
What is Gap Cover?
Gap cover is a type of short-term insurance that provides cover for the shortfall between what your medical aid scheme pays and what healthcare providers actually charge. Unlike long-term insurance products that cover you for an extended period or your entire lifetime, gap cover is a short-term insurance policy designed to protect you from unexpected medical expenses.
While medical aid covers your day-to-day and in-hospital benefits according to your plan’s limits, it often falls short when specialists charge above the scheme tariff. This is where gap cover steps in—bridging the gap so you’re not left paying thousands out of pocket.
How Does Gap Cover Work?
Gap cover works by covering the difference between what your medical scheme is willing to pay and the rates charged by medical professionals. This shortfall can result in significant out-of-pocket payments, even for members on comprehensive medical aid options.
For example, if your medical aid pays R20,000 for a procedure but your surgeon bills R45,000, you face a R25,000 shortfall. Gap cover can pay this difference, subject to your policy’s terms and annual limits.
It’s important to note that gap cover is not a substitute for medical aid scheme membership—you must be on a registered medical aid to qualify for gap cover.
What Does TRA Gap Cover Include?
TRA Gap Cover includes cover for procedures such as:
- All emergency procedures
- Sterilisations
- Vasectomies
- Tonsillectomies
- Appendectomies
- Gall bladder removal
- Prescribed Minimum Benefits (PMBs) where a medical aid has failed to meet its full obligations
- Conditions not specifically excluded where a medical aid has failed to meet its obligations
There is no entry age limit, and there is an aggregate annual limit of R150,000 per insured person per annum. Different coverage options are available,i ncluding entry-level, comprehensive cover, and high-end options—to cater to different health needs and budgets.
Short-Term Insurance vs Long-Term Insurance
Understanding the difference between short-term and long-term insurance helps clarify where gap cover fits:
| Aspect | Short-Term Insurance | Long-Term Insurance |
|---|---|---|
| Coverage period | Limited time period (usually 12 months, renewable) | Extended period or entire lifetime |
| Examples | Gap cover, car insurance, home insurance, travel insurance | Life insurance, retirement annuities |
| Purpose | Protect against specific risks and unforeseen circumstances | Financial support for major life events like death or retirement |
| Premium structure | Monthly premium based on current risk | Premiums may be fixed or increase over time |
Gap cover falls under short-term insurance because it renews annually and protects you against specific medical shortfall risks rather than providing a lump sum payout for life-changing events.
Why South Africans Need Gap Cover
Medical costs in South Africa continue to rise faster than inflation. Specialists are not bound by medical aid tariffs and can charge whatever the market allows. Without gap cover, you carry the full risk of these shortfalls.
Gap cover provides financial security by covering unexpected events such as an emergency surgery or unplanned hospitalisation which usually result in unplanned expenses, straight out of your pocket. For a relatively low monthly premium, you gain peace of mind knowing that you’re protected.
Choosing the Right Gap Cover Policy
When comparing gap cover options, consider:
- Annual limits – What is the maximum the policy will pay per year?
- Procedures covered – Does the policy cover your specific needs?
- Waiting periods – How long before you can claim?
- Monthly premium – Does the cost fit your budget?
- Policy wording – Read the fine print to understand exclusions
An insurance broker can help you make an informed decision by comparing coverage options from different providers to find the right fit for your circumstances.
Get Covered Today
Gap cover short-term insurance ensures you have sufficient coverage to get the healthcare you deserve without the financial stress of unexpected shortfalls. yourself and your family.
Contact TRA to explore our gap cover options and find the plan that suits your needs.
