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Navigating the Medical Maze: How to Compare Gap Cover Plans in South Africa

Navigating the Medical Maze: How to Compare Gap Cover Plans in South Africa

In the constantly evolving landscape of medical wellness and healthcare in South Africa, it is becoming increasingly vital for individuals to protect themselves against unexpected medical costs. This is where gap cover plans step in to bridge the financial gap between what a given medical aid scheme will cover and what patients are actually required to pay at the end of the day.

However, with such a variety of options available today, choosing the right gap cover plan can be a daunting task. Total Risk Administrators is here to help guide you through the process of comparing gap cover plans as one of the go-to providers in South Africa, and with good reason.

Gap cover 101

One of the most asked questions we get in our line of work is, without a doubt, what is a gap cover plan, and why is it so important to have.

Having a gap cover plan in place will help you when there is a shortfall between what service providers charge and what your medical aid scheme will cover for in-hospital expenses. On this note, those considering gap cover should know that you can only get a gap cover plan if you currently have a medical aid plan.

How To Compare Plans: Where To Start

Most South Africans know that healthcare in our country is quite expensive; therefore, most medical aids cover the cost of in-hospital visits, GP visits, dentists, etc. However, not all medical aids will cover you entirely, and as a result, you will be left to fit the rest of the bill.

Gap cover steps in to cover those costs, depending on the type of cover you have, to mitigate the shortfall.

One way to compare gap cover providers would be doing some research on the various gap cover options. You can speak with a medical scheme advisor who can advise you on the type of gap cover plans that work well with the scheme that you are currently on. There are various personal and health-related preferences that you need to take into account. Make sure that you compare all the fees, the cover amounts, waiting periods and all the T & C’s with the particular plan that you are looking for.

Conveniently, all your research and comparisons can be done online. Sites such as can also assist with comparisons with added ease and convenience.

Determine Your Needs

The first step in comparing gap cover plans is to evaluate your specific healthcare needs and what you would require from a given plan. Consider your medical history, family size, and any chronic conditions that may be applicable.

This will help you identify the types of medical expenses most relevant to you. Are you concerned about in-hospital shortfalls, specialist fees, or both? Understanding your unique requirements is key to finding a plan that suits you.

In general, gap cover is a relatively inexpensive investment, with a range of options to suit a variety of budgets, needs, and preferences. With this, you can take a plan out for yourself or put your family members on your policy, depending on the given plan.

Many gap cover providers offer a free quote when you complete an online form, so it is important to be mindful of the information and read it clearly and carefully before committing to any provider. You also need to consider what your gap cover won’t necessarily cover you for, so it’s best to read the terms and conditions properly.

What You Pay vs. What You Get

Coverage and Benefits

When comparing gap cover plans, pay close attention to the respective coverage and benefits offered. Depending on the plan, basic cover might include in-hospital shortfalls, specialist fees, and various other medical expenses.

It is advisable to look for plans that offer added benefits like cancer cover, maternity cover, and day-to-day benefits. These benefits can not only significantly enhance the value of your gap cover plan but also add convenience and peace of mind to your daily life.


The cost of monthly premiums is a critical factor when comparing gap cover plans to truly understand the difference between each plan’s value. Finding a plan that provides the coverage you need at a price you can afford is essential.

TRA offers a range of plans with varying premium options to accommodate different budgets, ensuring that you can access quality gap cover without breaking the bank.

Customer Service and Reputation

A vital factor to consider is the reputation and customer service of the gap cover provider, often being the biggest indicator of what your experience may eventually be like.

Read reviews and seek recommendations from friends or family who may already have gap cover plans. TRA is known for its exceptional customer service and has built a strong reputation in South Africa for providing reliable gap cover to our valued clients.

T&C’s Apply

Waiting Periods

Most gap cover plans often come with waiting periods during which certain benefits may not be accessible until the stated period of time has lapsed. Compare the waiting periods of different plans to ensure they align with your needs and expectations, as well as when you would need the gap cover to kick in.

TRA proudly offers competitive gap cover plans, designed to protect your interests from day one. Having no waiting period for many specific procedures, these may include all emergency procedures, tonsillectomies, appendectomies, gall bladder removal, and others not explicitly excluded.

TRA gap cover provides immediate gap cover benefits for all policyholders except for a limited list of specific conditions and procedures. Under certain circumstances, immediate gap cover may be provided for many procedures, including where a medical aid has failed to meet its full obligation.

Exclusions and Limitations

Exclusions and limitations can vary from one gap cover plan to another. Review the fine print of each plan carefully to understand what is not covered.

TRA provides transparent information about exclusions and limitations, allowing you to make an informed decision about your gap cover option and plan accordingly.

Network Providers

Some gap cover plans may require you to use specific network providers to access full benefits. Evaluate whether your preferred healthcare providers are in-network or out-of-network, and choose a plan that aligns with your preferences.

TRA Has Your Back

Comparing gap cover plans can seem overwhelming, but it’s a crucial step in ensuring your financial well-being in the face of unexpected medical expenses. TRA stands out as a reputable and customer-focused gap cover provider in South Africa, offering comprehensive plans that cater to a wide range of needs and budgets.

Finding the best gap cover for you comes down to understanding your requirements and carefully examining the benefits and costs. From there, you can realistically consider important factors like waiting periods and limited exclusions, helping you make an informed decision that gives you peace of mind.

Gap cover is an investment that ensures you and your loved ones are protected when it matters most. TRA is here to help you choose the right gap cover for your personal needs. If you have any questions regarding anything related to TRA Gap Covercontact us and we will gladly assist. Alternatively, explore our website for more information on all things Total Risk Administrators.

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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