Gap Cover Health Insurance for Medical Aid Shortfalls

Gap Cover
Policies

Reliable
Gap Cover

Gap Cover is an insurance policy that covers the gap between what your medical aid pays and what service providers charge for in-hospital expenses. Healthcare in South Africa is expensive, and most medical aids only cover part of the healthcare providers’ actual rate.

Gap Cover offers you extra protection, covering the shortfall of your medical aid.
However, Gap Cover is not a medical aid and does not replace your medical aid.
Waiting periods may apply.

Unique benefits of our gap cover

Cover up to 700%

Fast Claim
Payouts

Easy Claims
Process

Excellent
Service

Out-of-hospital
Benefits

Affordable Prices
From R99 p/m

Automatic Claim
Submission

SOUTH AFRICAN
GAP COVER PRODUCTSby TRA that cover your needs

SOUTH AFRICAN
GAP COVER PRODUCTSby TRA that cover
your needs

Basic Cover 300

Our Entry Level Product

STANDARD BENEFITS
Gap Cover
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment
Shortfalls on Specialist Consultations
Casualty Cover and Casualty follow-up consultations
Oncology Gap
Accidental Death Cover
Policy Extender
TRA Assist powered by MobiMed
Travel benefit

From R99/m

Basic Cover 300

Our Entry Level Product

STANDARD BENEFITS
Gap Cover
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment
Shortfalls on Specialist Consultations
Casualty Cover and Casualty follow-up consultations
Oncology Gap
Accidental Death Cover
Policy Extender
TRA Assist powered by MobiMed
Travel benefit

From R99/m

Compare all products

	Basic Cover 300	Vital Cover Plus	Super Cover Plus	Absolute Cover Plus
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a)
Gap Cover Percentage*	300%	700%	700%	700%
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* Applies to authorised in-hospital and in-lieu of hospital procedures, where the medical aid pays a portion of the fees from its in-hospital or major medical benefit. (Includes MRI/ CT/PET scans consumables.)	R500* per policy p/a*	R1 000* per policy p/a*	Up to R3 000* per policy p/a*	Up to R5 000* per policy p/a*
PMB's* Covered, subject to medical aid review
Shortfalls on Specialist Consultations* Cover for the shortfall on a specialist account related to the consultation in the rooms before a member is going for an in-hospital procedure. Limited to the following number of consults p.p.p.a (up to a max of R500 per consult)	1 consult per policy p/a*	2 consult per policy p/a*	3 consult per policy p/a*	4 consult per policy p/a*
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services.				Unlimited but subject to the aggregate annual limit per insured person per annum p/a*
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks)		Up to R13 650* per policy p/a*	Up to R63 000* per policy p/a*	Unlimited*
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments / deductibles per policy per annum to a combined maximum of R16 800*
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS			1 MRI / CT / PET scan per policy p/a up to R12 600*	2 scans per policy p/a. Unlimited but subject to the aggregate annual limit per insured person p/a*
SUB-LIMITS*: INTERNAL PROSTHESES		Up to R5 775* per policy p/a	Up to R11 550* per policy p/a	Unlimited Up to R68 250* per event
SUB-LIMITS*: MRI / CT / PET SCAN			1 MRI, CT or PET scan up to R3 780* per scan	2 MRI, CT or PET scan up to R6 300* per scan
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES			Up to R13 650* per policy per annum Up to R3 780* per event	Up to R23 100* per insured person per annum Up to R6 300* per event
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital) Accidents only. Children under the age of 8 ONLY - May be admitted for any treatment between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday.	Up to R3 465* per policy p/a	Up to R9 240* per policy p/a	Up to R13 650* per policy p/a	Up to R23 100* per policy p/a
Casualty follow-up consultations (The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)
GLOBAL FEE BENEFIT*			Up to R12 600* per policy p/a	Up to R25 200* per policy p/a
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit)	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)*		Up to R13 650* per policy p/a	Up to R63 000* per policy p/a	Unlimited*
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments per policy per annum up to a combined limit of R16 800*
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit)			Up to R36 750* per policy per annum	Unlimited*
ONCOLOGY “NEW-TECH” BENEFIT*			Up to R8 610* per policy p/a	Up to R17 325* per policy p/a
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*			Up to R18 900* per policy p/a	Up to R36 750* per policy p/a
MEDICAL AID CONTRIBUTION WAIVER Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed.		6 months. Up to a max of R4 620 per month.	6 months. Up to a max of R5 775 per month.	6 months. Up to a max of R6 930 per month.
Maternity Follow-Up Consultations Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth			Up to R7 00* per policy p/a	Up to R1 250* per policy p/a
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred.
For Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2 100 per day, for a total of 3 consecutive days
For Non-Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2100 per day, for a total of 3 consecutive days
ACCIDENTAL DEATH Insured / Spouse	R7 350	R10 500	R21 000	R31 500
ACCIDENTAL DEATH Dependant	R4 200	R5 775	R8 400	R21 000
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder)
TRAVEL BENEFIT
Emergency Medical and Related expenses up to R1 000 000.
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500.
Baggage Delay (more than 4 hours) R500
Baggage Delay (more than 24 hours) R1 000
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions.
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month.		R 360	R 380	R 620
Premium per Individual per policy per month	R 99
Premium per Family per policy per month	R 180
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month.	R 360	R 540	R 570	R 770

Vital Cover Plus

Our 2nd entry level product

ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover (including for Oncology)
Sub-Limit Cover (internal prostheses)
Medical Aid Contribution Waiver

From R360/m

Vital Cover Plus

Our 2nd entry level product

ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover (including for Oncology)
Sub-Limit Cover (internal prostheses)
Medical Aid Contribution Waiver

From R360/m

Compare all products

	Basic Cover 300	Vital Cover Plus	Super Cover Plus	Absolute Cover Plus
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a)
Gap Cover Percentage*	300%	700%	700%	700%
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* Applies to authorised in-hospital and in-lieu of hospital procedures, where the medical aid pays a portion of the fees from its in-hospital or major medical benefit. (Includes MRI/ CT/PET scans consumables.)	R500* per policy p/a*	R1 000* per policy p/a*	Up to R3 000* per policy p/a*	Up to R5 000* per policy p/a*
PMB's* Covered, subject to medical aid review
Shortfalls on Specialist Consultations* Cover for the shortfall on a specialist account related to the consultation in the rooms before a member is going for an in-hospital procedure. Limited to the following number of consults p.p.p.a (up to a max of R500 per consult)	1 consult per policy p/a*	2 consult per policy p/a*	3 consult per policy p/a*	4 consult per policy p/a*
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services.				Unlimited but subject to the aggregate annual limit per insured person per annum p/a*
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks)		Up to R13 650* per policy p/a*	Up to R63 000* per policy p/a*	Unlimited*
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments / deductibles per policy per annum to a combined maximum of R16 800*
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS			1 MRI / CT / PET scan per policy p/a up to R12 600*	2 scans per policy p/a. Unlimited but subject to the aggregate annual limit per insured person p/a*
SUB-LIMITS*: INTERNAL PROSTHESES		Up to R5 775* per policy p/a	Up to R11 550* per policy p/a	Unlimited Up to R68 250* per event
SUB-LIMITS*: MRI / CT / PET SCAN			1 MRI, CT or PET scan up to R3 780* per scan	2 MRI, CT or PET scan up to R6 300* per scan
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES			Up to R13 650* per policy per annum Up to R3 780* per event	Up to R23 100* per insured person per annum Up to R6 300* per event
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital) Accidents only. Children under the age of 8 ONLY - May be admitted for any treatment between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday.	Up to R3 465* per policy p/a	Up to R9 240* per policy p/a	Up to R13 650* per policy p/a	Up to R23 100* per policy p/a
Casualty follow-up consultations (The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)
GLOBAL FEE BENEFIT*			Up to R12 600* per policy p/a	Up to R25 200* per policy p/a
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit)	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)*		Up to R13 650* per policy p/a	Up to R63 000* per policy p/a	Unlimited*
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments per policy per annum up to a combined limit of R16 800*
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit)			Up to R36 750* per policy per annum	Unlimited*
ONCOLOGY “NEW-TECH” BENEFIT*			Up to R8 610* per policy p/a	Up to R17 325* per policy p/a
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*			Up to R18 900* per policy p/a	Up to R36 750* per policy p/a
MEDICAL AID CONTRIBUTION WAIVER Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed.		6 months. Up to a max of R4 620 per month.	6 months. Up to a max of R5 775 per month.	6 months. Up to a max of R6 930 per month.
Maternity Follow-Up Consultations Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth			Up to R7 00* per policy p/a	Up to R1 250* per policy p/a
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred.
For Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2 100 per day, for a total of 3 consecutive days
For Non-Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2100 per day, for a total of 3 consecutive days
ACCIDENTAL DEATH Insured / Spouse	R7 350	R10 500	R21 000	R31 500
ACCIDENTAL DEATH Dependant	R4 200	R5 775	R8 400	R21 000
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder)
TRAVEL BENEFIT
Emergency Medical and Related expenses up to R1 000 000.
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500.
Baggage Delay (more than 4 hours) R500
Baggage Delay (more than 24 hours) R1 000
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions.
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month.		R 360	R 380	R 620
Premium per Individual per policy per month	R 99
Premium per Family per policy per month	R 180
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month.	R 360	R 540	R 570	R 770

Super Cover Plus

Our mid-range product

ALL VITAL COVER BENEFITS PLUS
Out of Network Co-Payment Cover (including for Oncology)
Co-Payment: Out of Hospital MRI/CT/PET Scans
Sub-Limit Cover for MRI/CT/PET scans and Colonoscopies and Gastroscopies
Global Fee Benefit
Oncology Extender Benefit
Oncology “New-Tech” Benefit
Oncology Gap Benefit for Breast Reconstruction Surgery
Maternity Follow-Up Consultations
Private Ward Benefit

From R380/m

Super Cover Plus

Our mid-range product

From R380/m

COMPARE ALL PRODUCTS

	Basic Cover 300	Vital Cover Plus	Super Cover Plus	Absolute Cover Plus
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a)
Gap Cover Percentage*	300%	700%	700%	700%
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* Applies to authorised in-hospital and in-lieu of hospital procedures, where the medical aid pays a portion of the fees from its in-hospital or major medical benefit. (Includes MRI/ CT/PET scans consumables.)	R500* per policy p/a*	R1 000* per policy p/a*	Up to R3 000* per policy p/a*	Up to R5 000* per policy p/a*
PMB's* Covered, subject to medical aid review
Shortfalls on Specialist Consultations* Cover for the shortfall on a specialist account related to the consultation in the rooms before a member is going for an in-hospital procedure. Limited to the following number of consults p.p.p.a (up to a max of R500 per consult)	1 consult per policy p/a*	2 consult per policy p/a*	3 consult per policy p/a*	4 consult per policy p/a*
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services.				Unlimited but subject to the aggregate annual limit per insured person per annum p/a*
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks)		Up to R13 650* per policy p/a*	Up to R63 000* per policy p/a*	Unlimited*
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments / deductibles per policy per annum to a combined maximum of R16 800*
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS			1 MRI / CT / PET scan per policy p/a up to R12 600*	2 scans per policy p/a. Unlimited but subject to the aggregate annual limit per insured person p/a*
SUB-LIMITS*: INTERNAL PROSTHESES		Up to R5 775* per policy p/a	Up to R11 550* per policy p/a	Unlimited Up to R68 250* per event
SUB-LIMITS*: MRI / CT / PET SCAN			1 MRI, CT or PET scan up to R3 780* per scan	2 MRI, CT or PET scan up to R6 300* per scan
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES			Up to R13 650* per policy per annum Up to R3 780* per event	Up to R23 100* per insured person per annum Up to R6 300* per event
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital) Accidents only. Children under the age of 8 ONLY - May be admitted for any treatment between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday.	Up to R3 465* per policy p/a	Up to R9 240* per policy p/a	Up to R13 650* per policy p/a	Up to R23 100* per policy p/a
Casualty follow-up consultations (The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)
GLOBAL FEE BENEFIT*			Up to R12 600* per policy p/a	Up to R25 200* per policy p/a
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit)	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)*		Up to R13 650* per policy p/a	Up to R63 000* per policy p/a	Unlimited*
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments per policy per annum up to a combined limit of R16 800*
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit)			Up to R36 750* per policy per annum	Unlimited*
ONCOLOGY “NEW-TECH” BENEFIT*			Up to R8 610* per policy p/a	Up to R17 325* per policy p/a
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*			Up to R18 900* per policy p/a	Up to R36 750* per policy p/a
MEDICAL AID CONTRIBUTION WAIVER Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed.		6 months. Up to a max of R4 620 per month.	6 months. Up to a max of R5 775 per month.	6 months. Up to a max of R6 930 per month.
Maternity Follow-Up Consultations Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth			Up to R7 00* per policy p/a	Up to R1 250* per policy p/a
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred.
For Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2 100 per day, for a total of 3 consecutive days
For Non-Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2100 per day, for a total of 3 consecutive days
ACCIDENTAL DEATH Insured / Spouse	R7 350	R10 500	R21 000	R31 500
ACCIDENTAL DEATH Dependant	R4 200	R5 775	R8 400	R21 000
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder)
TRAVEL BENEFIT
Emergency Medical and Related expenses up to R1 000 000.
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500.
Baggage Delay (more than 4 hours) R500
Baggage Delay (more than 24 hours) R1 000
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions.
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month.		R 360	R 380	R 620
Premium per Individual per policy per month	R 99
Premium per Family per policy per month	R 180
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month.	R 360	R 540	R 570	R 770

Absolute Cover Plus

Our flagship product

ALL SUPER COVER PLUS BENEFITS PLUS
Emergency Medical Services (ambulance)

From R620/m

Absolute Cover Plus

Our flagship product

ALL SUPER COVER PLUS BENEFITS WITH
HIGHER LIMIT AMOUNTS.

From R620/m

Compare all Products

	Basic Cover 300	Vital Cover Plus	Super Cover Plus	Absolute Cover Plus
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a)
Gap Cover Percentage*	300%	700%	700%	700%
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* Applies to authorised in-hospital and in-lieu of hospital procedures, where the medical aid pays a portion of the fees from its in-hospital or major medical benefit. (Includes MRI/ CT/PET scans consumables.)	R500* per policy p/a*	R1 000* per policy p/a*	Up to R3 000* per policy p/a*	Up to R5 000* per policy p/a*
PMB's* Covered, subject to medical aid review
Shortfalls on Specialist Consultations* Cover for the shortfall on a specialist account related to the consultation in the rooms before a member is going for an in-hospital procedure. Limited to the following number of consults p.p.p.a (up to a max of R500 per consult)	1 consult per policy p/a*	2 consult per policy p/a*	3 consult per policy p/a*	4 consult per policy p/a*
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services.				Unlimited but subject to the aggregate annual limit per insured person per annum p/a*
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks)		Up to R13 650* per policy p/a*	Up to R63 000* per policy p/a*	Unlimited*
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments / deductibles per policy per annum to a combined maximum of R16 800*
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS			1 MRI / CT / PET scan per policy p/a up to R12 600*	2 scans per policy p/a. Unlimited but subject to the aggregate annual limit per insured person p/a*
SUB-LIMITS*: INTERNAL PROSTHESES		Up to R5 775* per policy p/a	Up to R11 550* per policy p/a	Unlimited Up to R68 250* per event
SUB-LIMITS*: MRI / CT / PET SCAN			1 MRI, CT or PET scan up to R3 780* per scan	2 MRI, CT or PET scan up to R6 300* per scan
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES			Up to R13 650* per policy per annum Up to R3 780* per event	Up to R23 100* per insured person per annum Up to R6 300* per event
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital) Accidents only. Children under the age of 8 ONLY - May be admitted for any treatment between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday.	Up to R3 465* per policy p/a	Up to R9 240* per policy p/a	Up to R13 650* per policy p/a	Up to R23 100* per policy p/a
Casualty follow-up consultations (The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)	1 follow-up consultation per policy p/a at an ER unit (accident-related only)
GLOBAL FEE BENEFIT*			Up to R12 600* per policy p/a	Up to R25 200* per policy p/a
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit)	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum	Unlimited but subject to the aggregate annual limit per insured person per annum
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)*		Up to R13 650* per policy p/a	Up to R63 000* per policy p/a	Unlimited*
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK)			1 co-payment per policy per annum. Up to R5 250*	2 Co-payments per policy per annum up to a combined limit of R16 800*
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit)			Up to R36 750* per policy per annum	Unlimited*
ONCOLOGY “NEW-TECH” BENEFIT*			Up to R8 610* per policy p/a	Up to R17 325* per policy p/a
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*			Up to R18 900* per policy p/a	Up to R36 750* per policy p/a
MEDICAL AID CONTRIBUTION WAIVER Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed.		6 months. Up to a max of R4 620 per month.	6 months. Up to a max of R5 775 per month.	6 months. Up to a max of R6 930 per month.
Maternity Follow-Up Consultations Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth			Up to R7 00* per policy p/a	Up to R1 250* per policy p/a
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred.
For Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2 100 per day, for a total of 3 consecutive days
For Non-Childbirth			Limited to a maximum of R525 per day, for a total of 3 consecutive days	Limited to a maximum of R2100 per day, for a total of 3 consecutive days
ACCIDENTAL DEATH Insured / Spouse	R7 350	R10 500	R21 000	R31 500
ACCIDENTAL DEATH Dependant	R4 200	R5 775	R8 400	R21 000
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder)
TRAVEL BENEFIT
Emergency Medical and Related expenses up to R1 000 000.
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500.
Baggage Delay (more than 4 hours) R500
Baggage Delay (more than 24 hours) R1 000
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions.
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month.		R 360	R 380	R 620
Premium per Individual per policy per month	R 99
Premium per Family per policy per month	R 180
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month.	R 360	R 540	R 570	R 770

*SUBJECT TO AN AGGREGATE ANNUAL LIMIT OF R210 580 PER INSURED PERSON
This limit may be subject to regulatory amendment. Sub-Limits may apply. Refer to the Policy Document for full details of limitations and exclusions.
Terms and Conditions apply. This product comparison does not constitute advice. Consult your intermediary for guidance in choosing the product that is right for your needs. Prescribed Minimum Benefits (PMB’s) are covered. Errors and Omissions Excepted. A full list of 2025 terms and conditions can be viewed here.

With TRA, signing up for Gap Cover is a breeze. In just 5 minutes, you can secure comprehensive coverage that fills the gaps in your medical aid shortfalls.

Gap Cover Tool

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Not sure if you need Gap Cover?
Just tell us about yourself and your medical aid, and we’ll let you know if it’s important for you. Here, we make finding the right gap cover easy. With our simple tools and expert help, you’ll quickly find the perfect policy for your needs.

DON’T STRESS!

WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES
AND WHAT YOUR MEDICAL AID PAYS.

WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES AND WHAT YOUR MEDICAL AID PAYS.

Gap Cover eliminates financial stress in case of hospitalisation by protecting you from medical shortfalls. Never assume that your medical aid will cover 100% of your in-hospital expenses.

Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.

Gap Cover eliminates financial stress in case of hospitalisation by protecting you from medical shortfalls. Never assume that your medical aid will cover 100% of your in-hospital expenses.

Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.

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