Bloemfontein & Hopetown

Gap Cover that protects you
from unexpected medical bills

Your medical aid doesn't always cover the full cost of hospital treatment. Gap Cover bridges the difference,
so you're not left with thousands in out-of-pocket expenses when you need care most.

Get your Gap Cover today Find out what you're covered for

What is

Gap Cover?

Gap Cover is a short-term insurance product designed to cover the "gap" between what your medical scheme pays and what healthcare providers actually charge, especially for in-hospital treatment.
Here's the reality: specialists are legally allowed to charge multiple times the medical scheme rate. Your medical aid may only pay a portion of that bill, leaving you responsible for the difference. In some cases, that shortfall can run into thousands of rands for a single procedure.

Gap Cover steps in to reduce or eliminate those unexpected out-of-pocket costs.

It's not a replacement for medical aid. It works alongside your existing medical scheme to provide an essential financial safety net when you're admitted to hospital, undergo surgery, or require specialist care.
We arrange Gap Cover for clients in Bloemfontein, Hopetown, and across South Africa.

What Gap Cover protects against

  • Specialist fees charged above your medical scheme rate
  • Co-payments required by your medical aid for certain procedures
  • Sub-limits that leave gaps in your cover
  • Shortfalls on cancer treatment and related costs
  • Unexpected bills from accidental injuries and trauma events
  • Financial strain after emergency hospital admissions

How Gap Cover

protects your finances

A single hospital admission can cost you thousands in shortfalls. Gap Cover ensures your financial plan stays intact, no matter what happens.

Covers shortfalls on in-hospital specialist fees

When specialists charge above your medical scheme rate, Gap Cover pays the difference, so you're not left with a massive bill after treatment.

Protection against co-payments & sub-limits

Many medical schemes require co-payments for certain procedures or impose limits on specific treatments. Gap Cover helps cover these costs.

Additional benefits for serious illness & trauma

Most Gap Cover policies include enhanced benefits for cancer treatment, accidental injuries, and trauma events, providing extra financial support when you need it most.

Prevents unexpected medical expenses from derailing your finances

Without Gap Cover, a single hospital event can force you to dip into savings, disrupt investments, or even take on debt. This service acts as a financial buffer, allowing you to focus on recovery rather than worrying about bills.

When you need
this service

Gap Cover isn't just for people with chronic conditions or high medical risk. It's for anyone who wants to avoid financial surprises when they need hospital care.

You need Gap Cover if:

  • You're admitted to hospital and a specialist charges above your medical aid rate

    This is the most common scenario. Surgeons, anaesthetists, and other specialists often charge well above what your medical scheme covers.

  • You undergo a procedure that has a co-payment requirement

    Many medical schemes require you to pay a portion of certain procedures out of pocket. Gap Cover helps cover this.

  • You receive cancer treatment with limits on your medical scheme

    Cancer treatment can be expensive, and medical schemes often impose annual limits. Gap Cover provides additional financial support.

  • You experience an accident or trauma event requiring urgent care

    Emergency hospital admissions can result in significant shortfalls, especially if multiple specialists are involved.

What happens without

Gap Cover in place?

Many people assume their medical aid covers everything. Unfortunately, that's rarely the case and the financial consequences of a single hospital event can be severe.

Common mistakes

  • Assuming their medical aid covers 100% of all costs

    When a medical scheme says it pays "100%," that refers to 100% of the scheme rate, not the doctor's actual charge. The difference can be substantial.

  • Not understanding that doctors can charge well above scheme rates

    Specialists are legally allowed to charge multiple times the medical aid rate. Without Gap Cover, you pay the difference.

  • Choosing cheaper medical aid plans without considering shortfall risks

    Lower-tier medical aid options often have higher co-payments and lower specialist rates, increasing your exposure to shortfalls.

Without Gap Cover in place, here's what can happen:

  • You pay the difference out of your own pocket

    Shortfalls can range from a few hundred to tens of thousands of rands, depending on the procedure.

  • Medical bills become financially overwhelming

    A single hospital stay can derail your budget and create unexpected financial stress.

  • Savings, emergency funds, or investments may need to be used

    Money you've set aside for other goals gets redirected to cover medical costs.

  • In severe cases, clients may take on debt

    Some people are forced to use credit cards or personal loans to cover medical shortfalls.

How we set up
your Gap Cover

Getting Gap Cover in place is straightforward. We guide you through every step to ensure you have the right level of protection.

What we need from you:

  • ID and personal details
  • Medical scheme membership details
  • Medical history (for underwriting purposes)
  • Information about dependants on your plan
  • Banking details for premium payments

Step 1

Needs
analysis

We assess your current medical aid plan and identify your potential exposure to shortfalls based on your coverage level and family needs.

Step 2

Plan
selection

We recommend the most suitable Gap Cover option based on your risk profile, medical scheme, and budget.

Step 3

Application
submission

You complete a simple application form with the necessary details.

Step 4

Underwriting
review

The insurer assesses your application. This usually takes a few days.

Step 5

Policy
activation

Once approved, your cover begins. Please note that waiting periods may apply before full benefits are accessible.

Timeline

Application approval: Usually within a few days
Waiting periods: General, condition-specific, or pregnancy-related waiting periods may apply depending on when you join and your circumstances

Your Gap Cover

questions answered

Is Gap Cover a replacement for medical aid?

No, it works alongside your medical scheme, not as a substitute. You must have an active medical aid membership to qualify for Gap Cover.

Medical aids often don't cover the full cost of in-hospital treatment, especially specialist fees. Doctors can legally charge well above the medical scheme rate, and you're responsible for the difference. Gap Cover protects you from these shortfalls.

No, it focuses mainly on in-hospital shortfalls and specific additional benefits like cancer treatment and trauma cover. It does not cover everyday medical costs like GP visits or chronic medication.

Yes, most policies have general and condition-specific waiting periods, depending on when you join and your circumstances. This is why it's important to get Gap Cover in place before you need it.

Yes, benefits are usually subject to annual limits and regulatory caps. We'll help you understand your policy limits and ensure you have appropriate coverage.

Common myths about
Gap Cover

Many clients come to us with understandable, but risky, assumptions about Gap Cover and medical aid. Here are the most common misconceptions we clarify:

Myth

"My medical aid pays 100%, so I'm fully covered"

100% refers to the scheme rate, not the doctor's actual charge. If a specialist charges 300% of the scheme rate and your medical aid pays 100% of the scheme rate, you're still responsible for the 200% difference. Gap Cover bridges that gap.

Myth

"Gap Cover pays everything"

Gap Cover covers defined shortfalls within specific limits and rules. It's not unlimited, and it doesn't cover all medical expenses, just the gaps left by your medical scheme for in-hospital treatment.

Myth

"I can sign up when I need it"

Waiting periods mean you must have Gap Cover in place before a medical event occurs. You can't take out cover once you're already facing a procedure or diagnosis and expect immediate benefits.

Myth

"I'm young and healthy, so I don't need it"

Accidents and unexpected health issues don't discriminate by age. A single emergency hospital admission can result in significant shortfalls, regardless of how healthy you are today.

Myth

"Gap Cover is too expensive"

Compared to the potential cost of a single hospital shortfall (which can run into tens of thousands of rands), Gap Cover premiums are a small price to pay for financial peace of mind.

Gap Cover isn't about expecting the worst; it's about being prepared so that when life happens, your finances don't fall apart.

Partnered with South Africa's leading
gap cover providers

Don't let medical shortfalls catch you off guard.

Protect yourself from unexpected hospital bills. Let's find the right Gap Cover solution for your medical scheme and budget.
Visit us in Bloemfontein or Hopetown, or book an online consultation.

Get Gap Cover now Speak to an Advisor