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Gap Cover

Why Gap Cover is important

With medical scheme plans becoming more expensive and service providers starting to charge higher and higher rates, it makes sense to get an insurance product like gap cover that bridges the gap so you don’t end up being out of pocket. In essence, gap cover provides you with financial assistance on the portion of in-hospital specialist bills which your normal medical scheme doesn't cover.

Bear in mind that gap cover only pays for in-hospital care - not day-to-day medical expenses. If you’ve had to pay for hospital procedures and treatment in hospital, you’ll know that there’s often a big difference between the cost of treatment and what your medical scheme pays for. Gap cover helps you pay for the shortfall and ensures that you don’t suffer financially due to unexpected medical expenses.

Please contact Completemed Healthcare Consultants on 0860 000 952 or email gapcover@completemed.co.za for any advice on the different gap cover options.

How it Works

How Medical Gap Cover Insurance Works.

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View the Frequently Asked Questions.

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Protect yourself against unexpected excess payments.

How Medical Gap Cover Insurance Works

Note: Graph values show actual payments made by medical aid
schemes and gap cover amounts paid out by Xelus (Pty) Ltd,
the administrator for Sanlam Gap Cover.

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The Sanlam Gap Cover plan covers the primary member and all dependants on your medical aid at the point of claiming.

Comprehensive Medical Gap Cover

  • R198 per month (younger than 60 years old)
  • R400 per month (60 years and older)

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Limit on Gap Cover Insurance Benefits

New regulations for gap cover stipulate that:

  • From 1 April 2017 any new policyholders will only be able to claim R 150 000 per year, for every insured individual on the policy. However, all existing gap cover policyholders, or anyone who takes out medical gap cover insurance up till 31 March 2017, will only be affected by this limitation of benefits from 1 January 2018.
  • The annual R 150 000 limitation per insured person, will not result in a reduction of premiums for existing gap cover policy holders.
  • Hospital cash-back plans will be limited to paying their clients a maximum of R3 000 per day, or a total lump sum of R20 000 per year, also either from 1 April 2017, or 1 January 2018, depending on whether you are a new policyholder or an existing one.

Frequently Asked Questions

In certain cases the cost for in-hospital procedures or outpatient treatment may exceed the base medical aid rate by 5-times. By taking out Sanlam Medical Gap Cover Insurance, you ensure that you and your family aren’t left with a large excess amount to settle.

  • You need to be an existing member of a registered medical aid scheme.
  • Gap cover extends to the principal member, their spouse and children up to age 27. Families covered on 2 medical aids will be covered by a single Sanlam Gap Cover policy.
  • Special dependents may be included.

Yes, the following waiting periods apply:

  • A general waiting period of 3 months on all benefits.
  • 12 months for pre-existing conditions for which you received advice or treatment during the 12 months prior to the cover commencing.
  • Treatment for obesity, including bariatric surgery (stomach stapling).
  • Treatment for cosmetic surgery unless necessitated by a trauma or as a result of oncology treatment (e.g. breast reconstruction following a mastectomy).
  • Any co-payment that is not a defined rand amount (i.e. it is applied as a percentage).
  • Any penalty, co-payment or limit applied by a medical scheme for not complying with the benefit rules or authorisation procedures (e.g. non-authorisation of a hospital admission or where the member is covered on a network plan and makes use of a non-network facility). Please note that this excludes the oncology co-payment cover.
  • Specialised Dentistry is only paid for on the Sanlam Gap Cover Comprehensive Plan in the event of trauma, cancers and tumours.
  • Claims older than 6 months.

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Loyalty Programmes

Loyalty programmes normally offer a variety of rewards - ranging from lifestyle, wellness, cash- back rewards and discounts to financial education programmes. Choose the programme that suits your needs.

Discovery Vitality

Vitality is a wellness programme that helps you live a healthier, more rewarding life.

Benefits include:

  • Up to 100% off gym membership
  • Healthy foods cash-back rewards
  • Discounted movie tickets
  • Savings on flights and holidays
  • Up to 50% off hotel accommodation
  • HealthyGear cash-back rewards
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Sanlam Reality

Sanlam Reality empowers and rewards you as you improve your financial wellbeing.

Benefits include:

  • Cash-back money saver cards
  • Discounted local and international flights
  • Free 1GB AlwaysOn Wi-Fi
  • Discount grocery coupons
  • Buy-1-get-1-free at Computicket
  • Discounted gym membership
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Momentum Multiply

Multiply is a wellness and rewards programme that inspires you to reach your goals.

Benefits include:

  • Up to R12 000 Health Returns
  • Up to 60% off Myriad premiums
  • Discounted Mango flights
  • Fixed 25% off gym fees
  • Discounted movie tickets
  • 50% off AVBOB funeral services
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Medical Scheme Options For Your Employeeshttp://www.sanlam.co.za/completemed/Pages/medical-scheme-options-for-employees.aspxMedical Scheme Options For Your EmployeesCompletemed offers appropriate advice when it comes to providing healthcare solutions for your employees.http://www.sanlam.co.za/CoZaBannerImages/CompletemedBanner_enployee.jpg?RenditionID=5, /CoZaBannerImages/CompletemedBanner_enployee.jpg?RenditionID=5
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