If you ask several people if they know what gap cover is, many might have a general idea, but often, there is a misconception surrounding how it works.
One common misconception is that you’re 100% covered for all in-hospital costs if you have a medical aid. Unfortunately, this is not the case.
Medical aid schemes have tariff rates, which means they cap certain procedures at a specific amount they will cover. If specialists charge above these rates, you have to pay the difference. This is where Gap Cover comes in.
What is Gap Cover?
Gap cover is designed to bridge the shortfall between what a service provider charges and what your medical aid pays for in-hospital, and certain out of hospital procedures. Gap Cover is not a medical aid, and it is not substitute for medical aid.
TRA’s 2025 Gap Cover Policies
At Total Risk Administrators (TRA), we offer four scaling gap cover products, ensuring there’s an option for everyone.
See our pricing table and compare our monthly premiums per policy; helping you to make the right choice when it comes to the best option to suit your needs:
Product |
Individual |
Families |
Over 65’s* |
Basic Cover 300 |
R99p/m |
R180p/m |
R360p/m |
Vital Cover plus |
R360p/m |
R540p/m |
|
Super Cover plus |
R380p/m |
R570p/m |
|
Absolute Cover plus |
R620p/m |
R770p/m |
Basic Cover 300
This entry-level option provides coverage for:
- Gap Cover for in-hospital shortfalls (up to 300% of medical aid scheme tariff).
- Casualty cover.
- A separate oncology gap cover benefit.
2025 Premiums:
- Individual: R99 p/m
- Families: R180 p/m
- Over 65’s: R360 p/m
View more on our Basic Cover 300 Product.
Vital Cover Plus
For those needing broader coverage, this option includes:
- Gap cover, casualty cover, co-payment cover, sub-limit cover, and a separate oncology benefit for gap and co-payment.
- Coverage of up to 700% above the medical aid scheme tariff.
2025 Premiums:
- Individual and Families: R360 p/m
- Over 65’s: R540 p/m
View more on our Vital Cover Plus Product.
3. Super Cover Plus
This mid-range product provides:
- Comprehensive coverage for gap cover, casualty cover, co-payment cover, sub-limit cover, and extra oncology benefits.
- Coverage of up to 700% above the medical aid scheme tariff.
2025 Premiums:
- Individuals: R380 p/m
- Over 65’s: R570 p/m
View more on our Super Cover Plus Product.
4. Absolute Cover Plus
Our flagship product offers the most extensive benefits, including:
- Unlimited oncology extender cover, gap cover, casualty cover, co-payment cover, and sub-limit cover.
- Coverage of up to 700% above the medical aid scheme tariff.
2025 Premiums:
- Individuals: R620 p/m
- Over 65’s: R770 p/m
View more on our Absolute Cover Plus Product.
For 2025, there are several new benefits which are comprehensive and exciting, including but not limited to (and option dependant):
– Shortfalls on specialist consultations
– Casualty follow-up consultations
– Maternity follow-up consultations
– Private ward benefits (including maternity)
Download our 2025 Gap Cover Brochure
Why Do I Need Gap Cover?
Your medical aid has limits set on in-hospital expenses; if a specialist charges more than these limits, you are left to pay the shortfall. This unexpected payment can put you under a lot of stress, especially during a medical emergency. Gap cover ensures your medical aid shortfall is covered, and you’re not left with unexpected bills.
Here’s why TRA’s Gap Cover is the smart choice:
- Affordable options tailored to different needs.
- Extensive coverage for oncology and in-hospital shortfalls.
- Coverage of certain out-of-hospital procedures.
- Reliable financial protection for unexpected medical costs.
View our Gap Cover Frequently Asked Questions (FAQ) for more.
Get Covered Today By The Best Gap Cover Provider in South Africa!
Total Risk Administrators is a trusted Gap Cover Provider for South Africans.
Protect yourself and your loved ones from unexpected medical aid shortfalls by choosing one of TRA’s Gap Cover options.
For more information, contact our specialists or visit our Gap Cover page.