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 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 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).
• Specialised Dentistry is only paid for on the Gap Cover Comprehensive Plan in the event of trauma, cancers and tumours.
• Claims older than 6 months.

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