With medical costs costing an arm and a leg in South Africa, many medical aid members are asking: Is an additional premium for gap cover worth it?
The short answer is yes. Why?
Well, could you afford an unexpected R20,000 shortfall out of pocket?
If we’re being honest, even R5,000 or R10,000 is hard to come up with when you’re not expecting it.
For a relatively low monthly premium over and above your medical aid, gap cover provides this financial protection against medical shortfalls and co-payments that your medical aid doesn’t fully cover.
TRA’s gap cover policies are designed to cover these hidden costs, giving you peace of mind when it matters most.
What is Gap Cover?
Gap cover is an insurance policy that works alongside your existing medical aid scheme. It’s not a substitute for medical aid, nor is it a short-term insurance product, but rather a safety net to bridge the gap between what your medical aid pays and what health professionals actually charge, especially specialists.
Many specialists charge significantly more than the medical aid tariff, leaving patients to fund the gap themselves. Without gap cover, you could be stuck with a large out-of-pocket bill, even for routine care, in-hospital treatment and procedures.
TRA’s gap cover policies help pay for:
- In- and certain out-of-hospital treatment and procedures
- Hospital co-payments
- Shortfalls for specialist consultations
- Oncology gap benefits for cancer treatment
- Dental procedures under specific conditions
- Sub-limit shortfalls on prostheses and scopes
Depending on your chosen plan, TRA will cover up to 700% above the medical aid tariff for approved procedures—making it one of the most extensive offerings available from a gap cover provider in South Africa.
Why the Growing Need for Gap Cover?
Healthcare costs continue to rise, and your medical aid contributions are following suit. In many cases, however, your medical scheme doesn’t cover everything, even if you’re fully insured.
Moreover, if you don’t have gap cover to cover specialist shortfalls, hospital co-payments, co-payments for specific scopes, and out-of-hospital procedures, these costs can add up quickly and result in significant medical debt when patients are unprepared.
Understanding Patient Medical Debt in South Africa
Medical debt isn’t a straightforward concept. For patients, it refers to the bills left unpaid after receiving treatment. For healthcare providers, it impacts revenue flow, stability and resource allocation.
Why is this becoming such a widespread issue? A combination of rising healthcare costs, medical aid coverage gaps, and administrative complexity often leaves patients responsible for significant out-of-pocket expenses.
Economic Pressures and Coverage Gaps
South Africa’s high unemployment rate and limited access to credit mean many households are simply not financially prepared for unexpected medical costs. Even those with medical aid may find themselves exposed to significant shortfalls due to high deductibles, co-payments, and excluded services.
Gap cover is designed to address these medical expense shortfalls directly, giving those with medical aid added financial protection from falling into debt.
How Does TRA Offer the Best Gap Cover For South Africans?
TRA is rated among the top 3 gap cover providers in South Africa, with a 9.7 Trust Index score on Hellopeter based on our customer reviews. With up to 700% cover, fast claim payouts, out-of-hospital benefits, and premiums from just R99 p/m, TRA delivers trusted, affordable protection against your medical aid shortfalls.
TRA Offers Comprehensive, Well-Rounded Cover
TRA Gap Cover Plans for 2025:
- All cover up to 700% above medical aid tariffs, except the Basic Cover plan, which covers up to 300%
- Include Casualty Unit Benefits, Specialist Shortfall Cover and Dental Shortfalls (with conditions)
- Offer Oncology Co-Payment support and extended oncology gap benefits
- Provide cover for hospital co-payments, global fees, and specific procedures
- Include benefits like trauma counselling, roadside security assistance, and travel insurance for gap cover policyholders under a certain age (71)
TRA Offers Affordable, Tiered Plans
Monthly premiums start from:
- R99 p/m for individuals
- R180 p/m for families
- And range from R360–R770 p/m dependent on age and plan
You’re also covered for accidental death, and the policy includes a medical aid contribution waiver in the event of the main member’s passing.
TRA Offers Gap Cover With No General Waiting Period
TRA applies no general waiting periods on its gap cover policies. However, there are condition-specific waiting periods that apply:
- A 10-month condition-specific waiting period applies to select high-cost procedures (like scopes, joint replacements, or childbirth)
- A six-month pre-existing conditions waiting period
- A nine-month cancer diagnosis waiting period for new policyholders already diagnosed
These waiting periods are standard for most gap cover providers, helping ensure the system remains sustainable for all members.
So, Is Gap Cover Worth It?
We said it once, and we’ll say it again. Gap cover is absolutely worth it.
You don’t want to be stuck paying or unable to pay significant unexpected medical expenses, especially when the gap between what your medical scheme covers and what medical professionals charge you can be massive.
Gap cover is particularly valuable for:
- Families with young children or elderly dependents
- Individuals with ongoing medical expenses or chronic illnesses
- Anyone requiring frequent specialist care
- People seeking comprehensive healthcare coverage without paying for the most expensive medical aid cover
TRA Makes Gap Cover Worth It
TRA ranks among the top-rated gap cover providers in South Africa. We have a strong track record of fast claim turnaround times (three payouts per week) and customer satisfaction. Our policies are tailored to meet diverse needs, offering both entry-level and fully comprehensive options.
TRA continues to provide benefits you can count on.
Don’t let shortfalls derail your financial well-being and don’t risk falling into medical patient debt.
Contact TRA today to sign up for the perfect gap cover plan for you and your family.
