A sub-limit is a cap your medical aid places on a specific procedure or item, separate from your overall annual limit, and it is one of the most common reasons people end up paying thousands out of pocket despite being fully covered on paper.  Gap cover protects you by paying the shortfall a sub-limit creates, though it does so within its own rules, usually capped per hospital admission. Knowing where

Gap cover pays for some out-of-hospital procedures, but only a narrow, defined set, mostly scans and scope co-payments (and these must still be paid from your in-hospital or major medical benefit first)and specialist shortfalls tied to a hospital admission. It will not touch your everyday medical costs like GP visits, chronic medicine, or day-to-day expenses. If you are expecting it to cover any procedure done outside of a hospital, that