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Ask most people to name the pillars of good health and they will say nutrition and exercise. On The Inside TRAQ podcast, host Dr Avron Urison put a different question to guest Dr Alison Bentley: have we underestimated a good night’s sleep as the third pillar? Her answer is that sleep is not passive downtime. […]
Medical aid is not the safety net most members think it is. Even on a comprehensive plan, healthcare providers often charge more than what your medical aid pays for a procedure, and the difference then sits with the member to cover, not the scheme. That difference is known as a shortfall, and it’s what gap […]
Gap cover is a short-term insurance product designed to cover the financial shortfall between what your medical aid pays and the actual costs charged by private healthcare providers. In South Africa, medical aid schemes often reimburse healthcare services at a predetermined rate, known as the medical scheme tariff (MST). However, specialists and hospitals may charge […]
Most people picture one thing when they hear “medical aid”: a comprehensive plan with all the bells and whistles you hardly use. However, what people don’t often realise is that an entry-level hospital plan can still be a type of medical aid, registered and regulated under the same Medical Schemes Act just as any comprehensive […]
Are you aware of the annual aggregate limit for your medical aid or gap cover provider and how it can affect you and your family? Terms used in insurance can often be complicated and overwhelming. However, medical aid members need to understand what these terms mean and how they affect their medical scheme and short-term […]
A gynaecologist consultation in South Africa runs around R700 at published private practice rates, a self-pay Pap smear around R280, and a screening mammogram from roughly R1 200. Surgery changes the shape of the number entirely, with one practice quoting around R100 000 for a hysterectomy including theatre time and hospital fees. Your medical aid […]
TRA’s Female Cancer Cover runs across three plan levels. Grand pays R50 000 on confirmed diagnosis, Supreme pays R100 000, and Ultimate pays R150 000. The difference between them is the size of that payout and the premium attached to it. These plans were previously sold as Femme 50 and Femme 100. Those names were […]
Health and Financial Well-Being with TRA’s Female Cancer Cover The cost of cancer treatment in South Africa reaches into the hundreds of thousands of rand once surgery and oncology care are billed, and your medical aid carries only part of it. Two gaps are left behind. The first is the shortfall between what specialists charge […]
Gap cover matters for women because the treatments women are most likely to face, breast cancer surgery and gynaecological procedures among them, are often billed by specialists at rates far above what any scheme pays. TRA can cover that shortfall (up to 700% of the scheme tariff on its three upper plans, and up to […]
Yes. As a foreigner planning to live in South Africa for a longer period, you can join a medical aid scheme, provided you hold a valid passport, a current work, study, or residence visa, and have a South African bank account to pay your premiums. The benefits you receive are the same as those available […]
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, […]
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. […]
Some things just work better when they’re together; medical aid and gap cover are no exception. With medical treatment and specialist costs as high as they are, regardless of your medical aid scheme, there is often a shortfall in covering the full costs charged by healthcare providers. Without the perfect gap cover policy to pair […]
Taking out medical gap cover can prove life-saving, especially when you are admitted to a hospital and risk incurring shortfall costs. Medical aid scheme rules and regulations can be exasperating and frustrating to follow. Why do our medical aid benefits run out when we need them the most? And why do medical aids cover some […]
A hospital plan is one of the medical aid options in South Africa, regulated under the Medical Schemes Act, with the catch that it only pays for in-hospital costs. That means you still qualify for gap cover with a hospital plan, exactly as you would with comprehensive medical aid. Pairing the two often costs less […]
Yes, you can get gap cover with no waiting period in South Africa, but only if you transfer from another gap cover provider with similar benefits. TRA waives all standard waiting periods under this 90-day transfer rule, provided you apply within 90 days of cancelling your previous policy and submit a membership certificate as proof. […]
You qualify for gap cover in South Africa when you are a registered member of a medical aid scheme. Gap cover sits alongside your medical aid and pays the in-hospital shortfalls that arise when specialists charge more than the scheme’s tariff. You can extend the policy to your spouse and dependants who share your medical […]
Dis-chem Gap Cover and TRA Gap Cover are two of South Africa’s main gap insurance providers, but their plans differ on cover ceilings and on the number of plans each offers. Dischem covers up to 600% above scheme tariff across two plans (Base and Summit). TRA covers up to 700% across four plans, starting at […]
Gap cover for Discovery medical aid pays the in-hospital shortfalls your medical aid does not. When a specialist charges 300% of the Discovery Health Rate but your plan only pays 200%, you cover the difference out of pocket. TRA gap cover could settle that gap for authorised in-hospital procedures, up to 700% of scheme tariff. […]
Pre-existing conditions are the single most common reason people put off applying for gap cover. They are worried that a previous surgery, a chronic illness, a back problem or a cancer diagnosis from years ago will either disqualify them, or that they will end up paying premiums for a policy that quietly excludes the very […]
Understand the importance of sleep and how your sleep quality can affect your well-being. Watch TRA’s podcast episodes to find out more!
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Gap cover can shield you from unexpected medical expenses, discover the 5 reasons you need gap cover in South Africa.
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Gap cover pays the difference between what your medical aid covers and what specialists charge. TRA answers the question “What is Gap Cover?”
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