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Why investing in gap cover in 2022 is a good idea

Why investing in gap cover in 2022 is a good idea

Globally, we’re all in a financial pinch.

The cost of living has increased dramatically, and according to Statistics South Africa, the current inflation rate is 5.9%. The last time our country experienced an inflation rate this high was in 2017 at a rate of 6.6%.

That, of course, begs the question – which expenses stay and which expenses go?

Even though it might make sense to cut back on monthly bills, some of these costs are essential, especially regarding your and your family’s health.

Medical aid and gap cover are your health insurance for the future

For many years, being a medical aid member was considered a luxury, and people would opt to use the public healthcare system to reduce their monthly costs.

However, the chronic underfunding of public health in South Africa and the gradual increase in patient load has made healthcare facilities overburdened and understaffed.

Public healthcare patients often face poor infection control measures, long waiting times and poor service, and the situation is only getting worse. Public healthcare caters to approximately 80% of the South African population, whilst the remaining 20% belong to registered medical aids.

If you are a medical aid member, you and your family are financially protected if you suddenly incur high and unexpected medical costs. You can receive treatment at a private hospital instead of a crowded public hospital.

And if you are concerned about paying a steep monthly premium or wish to reduce your risk of financial debt even further, you might want to consider gap cover.

Gap cover

What is it?

Gap cover is a short-term insurance policy that provides extra protection for medical aid members. Gap cover covers the cost of the shortfall between the rates charged by private healthcare providers and your medical scheme tariff.

Gap cover provides financial assistance for in-hospital treatments and is paid in monthly premiums. The price of gap cover products can range from R99 per month to R495 per month.

You must already be a member of a medical aid to have gap cover. Your gap cover will also not provide cover if your medical aid has already paid the full amount for a procedure or if your medical aid does not pay for a procedure.

What does it cover?

All gap cover products will have slightly different benefits and will cover different amounts.

Gap cover options will provide cover for prescribed minimum benefits (PMBs) and will cover co-payments up to a certain amount per family per year.

Most gap cover options provide essential benefits such as medical aid imposed co-payments and in-hospital specialist gap cover. Some gap cover options will also pay for out-of-hospital procedures such as an MRI or CT scan.

Some gap cover companies will impose a general three-month waiting period. However, gap cover companies such as Total Risk Administrators do not set a waiting period.

What is the difference between gap cover and medical aid, and why do I need both?

Gap cover works with your medical aid but is not a substitute for a medical aid plan.

Your medical aid covers healthcare costs such as hospital procedures, appointments and medication. Gap cover covers the gap between what your medical aid covers and what your doctor charges.

So the question is no longer “Can I afford gap cover?”. The question is, “Can I afford to be without gap cover?”.

Even if you are a medical aid member, you could still have to pay for crippling medical expense shortfalls if you do not have gap cover in place.

Furthermore, you could be restricted to using certain providers at specific networks if you are a medical aid member without gap cover.

Why do I need gap cover while times are tough?

Why do I need gap cover while times are tough?

  1. Doctors are continuing to increase their rates

Professional medical providers can often charge up to six times more than your medical schemes’ base tariff.

Unfortunately, doctors are likely to continue increasing their rates even further due to South Africa’s inflation rate. A survey revealed that medical practitioners raised their fees by 5.7% on average in 2019, which has continued to increase since then.

This highlights the need for gap cover as it could save you from having to rely on the public healthcare system whilst protecting you from financial debt if you or a family member suffers from an unforeseen accident or illness.

  1. The increased risk of accidents and diseases has overwhelmed the public healthcare system

Prior to the Covid-19 pandemic, public hospitals in South Africa were already overwhelmed by cases of influenza, tuberculosis, HIV/AIDS, gun and knife violence and heart disease.

The pandemic overwhelmed the system even further, with over 2.91 million cases of infection since March 2020. Many hospitals had to turn away hundreds of people infected with coronavirus due to a lack of medical staff and equipment.

This has highlighted the importance of having high-quality healthcare. Having a medical aid and gap cover in place could help ensure that you and your family receive the best care during your time of need.

  1. Gap cover could reduce your expenses 

Paying the premium for a flagship gap cover product whilst being on a more affordable medical scheme could reduce monthly costs for individuals and still provide adequate cover in the event of an emergency.

Gap cover is a cost-effective way of insuring against the financial burden of high medical bills. You may be risking going into financial debt if you solely rely on your medical aid to cover your in-hospital costs in the event of an emergency.

Gap cover also gives you the freedom to be treated by private healthcare specialists that may have left you with a hefty medical bill that you would have had to pay without gap cover.

Gap Cover in 2022

It is clear that investing in gap cover in 2022 is not only a good idea but could help you avoid the unpredictable nature of South Africa’s public healthcare system whilst minimising the cost of your monthly premiums.

Speak to your health insurance broker to find a gap cover policy and service provider that suits your individual needs and budget.

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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