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 medical procedures while others only partially or not at all?
The Council for Medical Schemes has recommended that the industry limit contribution increases for 2026 to 3.3%, in line with projected consumer inflation, plus reasonable estimates of benefit utilisation.
This approach aims to help members maintain their coverage. However, it is not so simple.
The Council for Medical Schemes noted that many South African households continue to face financial constraints and that pressure on household budgets could affect members’ ability to afford medical scheme contributions.
These statistics indicate that South Africans face increased financial strain in affording their medical aids, which may lead to difficulties covering shortfalls.
The need for Gap Cover is ever-growing, but how do you find the best gap cover plan in South Africa? How do you find a Gap Cover plan you can afford? How do you differentiate between Gap Cover options?
Top 10 Gap Cover Plans in South Africa
We’ve compiled a list of some of the top gap cover options in South Africa, with their pricing, to help South Africans budget for their health insurance.
Please Note: Gap Cover is not the same as a medical aid and the cover is not a substitute for medical aid. Gap Cover is an insurance product over and above your medical aid to protect policyholders from medical aid shortfalls.
| Provider | Monthly Premium | Coverage Above Scheme Tariff | A Few Benefits |
| 1. TRA – Total Risk Administrators | From R99 | Up to 700% | Casualty, Co-payments, Sub-limits, certain dental procedures, global fee benefit, maternity private ward rate shortfalls, Travel Benefits, TRA Assist. |
| 2. Dis-Chem Health | From R219 | Up to 600% | Includes extensive in-hospital and out-of-hospital coverage for procedures, with specific benefits for oncology and accident-related incidents. It also offers Lifestyle Benefits for an additional fee. |
| 3. Discovery Gap Cover | From R270 | Up to 500% | Provides cover for in-hospital specialist claims, specific out-of-hospital costs, and co-payments on approved cancer-related claims, including international travel benefits and support for high-cost treatments. |
| 4. Turnberry | From R185 per family | Up to 600% | Covers MRI and CT scans, casualty benefits for accidents, critical illness, and first-time cancer diagnosis. |
| 5. Oneplan | From R220 | Up to 400% | Casualty, Scans & Scopes, Cancer Co-payment. |
| 6. Zestlife | From R276 for individuals < 35 years and R429 – R645 for individuals >35 | Up to 500% | Covers individuals, particularly under 35, for various medical shortfalls and specific conditions. |
| 7. Momentum | From R282 | Up to 1200% of Momentum Medical Scheme Rates* (Must be with Momentum Medical Aid) | Covers up to 3 times the medical aid rate for shortfalls, co-payments, casualty visits, internal prosthesis, cancer assist, and accident assist benefits. |
| 8. Liberty | From R276 for <35 years old | Up to 500% | Offers high levels of coverage for in-hospital and over 50 out-of-hospital procedures, co-payment cover for hospital admissions and scans, oncology cover, and additional benefits for emergency room visits and accidental dentistry. |
| 9. Sanlam | R346 for individuals under 60, R1079 for over 60 | Up to 600% | Covers tariff shortfalls, sub-limits, co-payments, deductibles and penalty co-payments, with special conditions for oncology and accidental casualty benefits. |
| 10. Stratum Benefits | From R330 per month for individuals | Up to 500% | Offers a range of plans including up to 500% gap cover, dental, maternity, radiology benefits, and more, tailored to cover in-hospital and specific out-of-hospital medical expense shortfalls. |
Please note that each policy has an overall annual limit of funds covered per insured person. This table is for basic comparison. Errors and Omissions Excepted. The table above does not constitute advice. It is a high-level summary of some of the benefits. Consult your intermediary for advice on the above products. Refer to individual policies and providers for full terms and conditions.
Choosing a Medical Gap Cover Provider
So many options out there, how do you choose?!
According to Statistics South Africa’s 2024 General Household Survey, only 15.5% of individuals in South Africa were members of a medical aid scheme, leaving roughly 85% of the population reliant on public health care. Medical aid coverage was highest in the Western Cape (25.4%) and Gauteng (21.3%), and lowest in Limpopo (10.0%) and KwaZulu-Natal (10.2%). It is evident that medical expenses, including having a medical scheme, are a significant financial burden for most South Africans
Thus, many factors must be considered when choosing the best gap cover provider.
Understand your financial and medical position as a starting point, then follow these 5 tips to optimise your medical cover when comparing gap cover providers.
5 Tips for Optimising Your Medical Aid – Gap Cover Comparison
1. Coverage
First, look for a policy that provides coverage for the specific medical procedures and services you may require. More importantly, make sure that the policy covers the gap between what your medical aid scheme pays and what your healthcare provider charges.
2. Cost
Consider the cost of the policy and whether it fits within your budget. Then, compare the monthly premiums and benefits of different policies to find the best value.
Note: When budgeting, note that the cost of gap cover will be separate from that of the medical scheme. Gap cover is not a substitute for your medical aid but an add-on should your medical scheme not cover the shortfall in a medical situation.
3. Provider network:
Check whether the policy covers the healthcare providers and facilities you and your family prefer or need to use.
4. Limits and exclusions:
Look carefully at any limits or exclusions on the policy to ensure it meets your needs. Some policies may have exclusions for pre-existing conditions, limits for in-hospital and out-of-hospital use, or annual or lifetime limits on coverage provided.
Note: 2026 sees an overall annual limit (aggregate annual limit) of R219 845 per insured person.
5. Reputation and customer service:
Consider the reputation of the insurance company offering the policy and their customer service record. Read reviews from other customers to get a sense of their experiences with the company.
Case Study with Hellopeter Reviews:
Checking the Reputation and Status of Your Medical Gap Cover Provider
In the search for “the best gap cover in South Africa,” we began with an organic Google search and consulted credible platforms such as Hellopeter to see others’ views and experiences regarding service issues, claims issues, or admin issues.
Even if your provider is not the “worst-rated insurance company”, poor service can lead to a lack of communication, customers being ignored, plenty of stress, and poor insurance ratings. Equally, when claims are not processed properly or not processed at all, the result is a lack of trust in the insurer. Companies that make big, empty promises to no avail quickly lose their standing while racking up poor reviews. Unauthorised deductions, debit orders being duplicated or not going off, suspicious charges, policies not being updated, incorrect details being added to claims, and the like are red flags for anyone searching for a reliable provider.
When it comes to your health, be sure to find a provider who cares and communicates clearly.
Gap Cover Comparison on Hellopeter
Hellopeter is an online platform that connects South African consumers and businesses. It allows consumers to share their experiences with businesses, whether positive or negative and read about other people’s honest experiences with businesses.
The Hellopeter platform proves to be a valuable source of information. Certain insurers stand out in terms of customer satisfaction, and reading through policyholder reviews is one of the clearest ways to gauge how a gap cover provider handles claims and communication.
Who offers the best gap cover in South Africa?
Total Risk Administrators (TRA) prides itself on offering gap cover plans that are affordable for South Africans, ensuring protection and coverage for you and your family.
TRA is underwritten by Auto&General Insurance Company Limited, recognised as the Best of the Best in two categories at The Star Readers’ Choice Awards, for the Best Car Insurance provider and Best Insurance Company (Personal). TRA customer reviews on platforms such as Hellopeter speak to the company’s commitment to integrity and efficiency.
Prioritise your health, prioritise your peace of mind and sign up for your TRA Gap Cover.
Download the TRA Gap Cover Brochure for 2026.
