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 are only partially or not at all?
The South African Council for Medical Schemes has suggested a medical aid scheme premium increase of about 5% plus utilisation for 2023/2024, potentially leading to closer to 8.5% hikes. These statistics indicate that South Africans face increased financial strain in affording their medical aid, which may lead to difficulties covering shortfalls.
The need for a Gap Cover is ever-growing, but how do you find the best gap cover plan in South Africa? How do you differentiate between Gap Cover Options?
Top 10 Gap Covers in South Africa
We’ve compiled a list of some of the top gap cover options in South Africa
| Provider | Monthly Premium | Coverage Above Tariff | A few of the Key Benefits |
| TRA | 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 |
| Oneplan | From R220 | Up to 400% | Casualty, Scans & Scopes, Cancer Co-payment |
| Zestlife | From R239 for individuals < 35 years and R372 – R548 for individuals >35 | Up to 500% | Covers individuals, particularly under 35, for various medical shortfalls and specific conditions |
| Turnberry | From R164 per family | Up to 500% | Covers MRI and CT scans, casualty benefits for accidents, critical illness, and first cancer diagnosis |
| Momentum | From R236 | Up to 1200% of Momentum Medical Scheme Rates* | Covers up to 3 times the medical aid rate for shortfalls, co-payments, casualty visits, internal prosthesis, cancer assist, and accident assist benefits |
| Dis-Chem Health | From R141 for adults 18-39 | 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. |
| Sanlam | R262 for individuals under 60, R526 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. |
| Discovery | From R143 | 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. |
| Liberty | From R239 for <35 years old | Up to 500% | It 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. |
| Stratum Benefits | From R275 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 for the above products. Gap Cover is not the same as a medical aid and the cover is not a substitute for medical aid.
- Refer to individual policies for full terms and conditions.
Choosing a Medical Gap Cover Provider
So many options out there, how do you choose?!
According to the latest data released by Statista, in 2022, only 15.8% of all individuals in South Africa were members of medical aid schemes, which accounts for around 9.7 million residents having private medical care. Approximately 84.2% or 52 million people are dependent on public health care. 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: 2024 sees an overall annual limit (aggregate annual limit) of R198 660 per insured injured 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 hear 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, communicates and offers clarity.
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.
Hellopeter proves to be a valuable source of information. Certain insurers stand out in terms of customer satisfaction. However, as of January 2024, Total Risk Administrators is top of the list for Gap Cover in South Africa.
Who offers the best gap cover in South Africa?
Total Risk Administrators (TRA) prides itself on offering the best gap cover plans ensuring the protection and coverage of you and your family.
Best of all, customer reviews from platforms such as Hellopeter, attest to the company’s integrity and efficiency, ranking it #1 Gap Cover in South Africa as of January 2024.
In South Africa, insurance has become almost mandatory to obtain full peace of mind in an emergency, especially when it comes to optimising your medical coverage. Prioritise your health, prioritise your peace of mind and sign up for your TRA Gap Cover.
