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What is Medical Gap Cover?

What is Medical Gap Cover?

Medical gap cover is not a medical insurance plan but a supplementary health insurance policy. It acts as a financial safety net, bridging the difference, or “gap,” between what your medical aid scheme pays for and the fees charged by private medical professionals should they be above your scheme’s allocated amount.

This cover for unexpected medical expenses provides additional financial protection and peace of mind beyond your standard medical aid coverage.

Why Medical Gap Cover Matters

A medical emergency can be daunting, whether it’s an accident or an illness requiring hospitalisation. Fortunately, most medical aid plans cover in-hospital expenses such as doctor’s consultations, prescribed medications, and even the cost of anaesthesia. However, your medical aid plan may not cover out-of-hospital services, which can create a financial gap.

For example, an anaesthetist may charge a fee that exceeds what your medical aid plan covers, resulting in a significant financial shortfall. This is where medical gap insurance comes in handy. It helps cover these extra costs, ensuring that you don’t have to bear the burden of out-of-pocket expenses during medical crises.

Maximising Your Coverage

  1. Extended Consultation Coverage: Your medical aid might limit the number of covered consultations or the reimbursement rate for specialists. Medical Gap Cover can step in to cover for these additional costs.
  2. Diagnostic and Ancillary Services: Often, diagnostic procedures such as MRIs, X-rays, or blood tests may not be fully covered by your medical aid, especially when performed out of the hospital. Gap cover can ensure you have access to comprehensive diagnostic services without financial strain.
  3. Pre- and Post-Hospitalisation Costs: Medical Gap Cover is not just a hospital expense shield; it’s a comprehensive solution. It can cover costs associated with treatment before hospital admission and follow-up care after discharge, which are often not fully covered by standard medical aid plans.
  4. Supplementary Therapies and Rehabilitation: In some cases, therapies like physiotherapy, chiropractic services, or occupational therapy, which are essential for complete recovery, might not be fully covered under your medical aid. Gap cover can be a lifesaver in such scenarios, providing financial assistance for these essential services.

Understanding the Scope of Medical Gap Cover

When you have a medical aid or medical scheme, there are often expenses that are not fully covered, such as co-payments or deductibles. Medical gap coverage can help cover the gap between what your medical aid or medical scheme covers and the actual medical treatment cost. This allows you more control over your healthcare expenses.

It’s important to note that the coverage and benefits offered by each policy may vary. Some policies may cover certain medical procedures or treatments that others do not. It’s crucial to carefully review the terms and conditions of any policy you’re considering to ensure that it meets your specific needs and provides the coverage you need most.

Note: There’s a nine-month waiting period for claims related to any form of cancer diagnosis if diagnosed before the policy starts.

About Total Risk Administrators

Total Risk Administrators (TRA) prioritise an incredible customer experience marked by fairness and integrity. We offer cost-efficient, beneficial, and relevant products backed by thorough information to help you make informed decisions. Our team ensures a seamless application, joining, and claiming process with unparalleled turnaround times. Our communication strategy is both structured and flexible. Keeping our brand top of mind while welcoming feedback for continuous improvement.

Tailored Gap Cover Packages by TRA

Recognising diverse healthcare needs, TRA offers four Gap Cover packages:

  1. Basic Cover 300: Starting at R99/month
  2. Vital cover Plus: Starting at R275/month
  3. Super Cover Plus: Starting at R300/month
  4. Absolute cover Plus: Starting at R535/month

Refer to our TRA Gap Cover brochure for detailed package information.

Addressing Your Gap Cover Questions and Concerns

For further inquiries about Gap Cover or other services, contact our specialists at Total Risk Administrators. We’re committed to providing tailored Gap Cover solutions for your unique healthcare needs, ensuring financial peace of mind during medical emergencies.

Click here to sign up with TRA.

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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