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How To Claim From Gap Cover: A Comprehensive Guide.

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As an insurance product designed to provide additional financial protection, gap cover helps individuals who are on a medical aid scheme further ensure they are covered when they need it most.

Helping bridge the gap between the high cost of medical charges from healthcare providers and the limited coverage provided by standard medical aid plans, gap cover steps in when you need to count on it.

Understanding how to claim from gap cover seamlessly is crucial to ensure you maximise the benefits as a valued client. As a trusted gap cover provider, TRA is here to guide you through the process of claiming from gap cover, ensuring you receive the reimbursement you deserve.

Is There One Process To Follow?

In order for your medical aid to cover your in-hospital procedures, they need to give you authorisation. You need to then check with your gap cover provider regarding covering the shortfall on what your medical aid will pay to the respective practitioners or hospital should your medical aid not cover the full amount.

You need to make sure that you have all the necessary paperwork and submit this to your gap cover provider. They will make sure that the correct payments are made so you don’t have to deal with the transfers yourself.

If you are unsure of the process, ensure you get all the information from your intermediary. You can ask them to explain the step-by-step process, as every gap cover provider may vary. Some require email correspondence; others might make use of their own applications or deal directly with your medical aid.

TRA’s Claiming Process

With the TRA Gap cover process, there are two manners in which a claim can be processed. These will suit different clients accordingly, being a manual process or an automatic process.

The manual process entails that you, as the Policyholder, need to submit the following:

  1. Claim from the Service Provider
  2. First two (2) pages of the hospital account showing the admission and discharge dates of the hospital event
  3. The Medical Aid statement shows the payment of the Service Provider claim and the reason for the short payment.

The automatic process entails that TRA will receive claims submitted by selected medical aid schemes on behalf of the Policyholder. Should your medical aid company have such an agreement with TRA, it is not necessary for the Policyholder to submit their claim to TRA.

TRA will receive an electronic version of the claim and will process the said claim within seven (7) working days of receipt thereof. However, co-payment and sub-limit claims still have to be submitted manually by the Policyholder.

Please refer to the full TRA Gap Cover Booklet to find out more information and ensure you understand the process and all it entails.

The Claiming Process: How To Go About It

When preparing to undergo the claiming process for all expenses relating to your gap cover, there are a few things to consider and include. This knowledge will help you navigate the claiming process more effectively and achieve the best possible outcome.

Understand Your Gap Cover Policy

Prior to making a claim, it is recommended to familiarise yourself with the details of your gap cover policy. Review the applicable coverage limits, terms and conditions, waiting periods, and any exclusions that may apply.

Gather Required Documentation

When submitting a claim, you will typically need to gather specific documentation, including medical invoices, medical aid statements, and applicable gap cover policy details.

Submitting a Claim

Once you have the necessary documentation, review relative claim submission requirements, complete any required forms and proceed to submit the claim.

Claim Processing and Communication

After submitting your claim, the gap cover provider will review the documentation and process your claim. This will involve assessing the validity of the claim, which will then be communicated to you as the gap cover client. The duration this takes will vary from gap cover provider to provider, also depending on the nature and magnitude of the gap cover claim itself.


If your claim has been approved, you will receive reimbursement for the eligible medical expenses. As mentioned, this is subject to the limits and coverage specified in your gap cover policy and differs accordingly. The reimbursement amount will be paid directly to you, helping offset the out-of-pocket expenses incurred.

Seek Assistance if Needed

If you encounter any difficulties during the claiming process or have questions regarding your gap cover policy, don’t hesitate to contact your gap cover provider’s customer service team. They can provide guidance, answer your queries, and assist you in navigating the claim procedure effectively.

At the end of the day, claiming from gap cover should be a simple process. No one has the time nor wants to spend hours on the phone trying to submit a claim to a gap cover provider. Most providers will have a different way or process in order to claim from gap cover, so talk to your intermediary about the process that you need to follow in order to get your claim processed.

TRA Has You Covered

Claiming from gap cover can be a straightforward process if you follow the necessary steps and provide accurate, completed documentation. By understanding your policy and submitting a well-prepared claim, you can increase your chances of a successful reimbursement. Remember to stay in touch with your gap cover insurer and seek their guidance whenever needed. By utilising your gap cover effectively, you make the most out of your gap cover and what it can do for you.

If you have any more queries or questions regarding anything related to TRA Gap Cover, why not reach out to our helpful specialists. You can also visit our website to learn more about TRA Gap Cover today.


Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on and matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.


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