Last reviewed: September 2026. We review our guides regularly to keep them accurate.
By Martin Janse van Rensburg, Sales Manager and Financial Advisor at Curemed. Reviewed by Roxanne Hurter-Ehlers, Director of People and Governance.
Gap Cover is a low-cost insurance policy that pays the difference between what a hospital specialist charges and what your medical scheme actually pays, so a big shortfall does not land on you. It is not a medical aid and it does not replace one. This guide explains how Gap Cover works in plain terms, then compares the seven main Gap Cover providers in South Africa for 2026 on the things that matter: the tariff shortfall multiple, co-payments, waiting periods, entry age rules and price. Every policy is capped by the same statutory annual limit of just over R220,000 per person per year, so the real differences sit in benefit structure, age rules and price.
In short
- Gap Cover tops up in-hospital specialist shortfalls and refunds many medical scheme co-payments. It works only alongside a registered medical scheme.
- Every Gap Cover policy carries the same statutory annual limit, about R219,846 per insured person for the 2025/26 period, rising with inflation each 1 April.
- Tariff shortfall cover across the seven main providers ranges from 100% to 700% above the medical scheme rate.
- Out-of-hospital cover is narrower than in-hospital cover and varies by plan, so read the plan schedule.
- Indicative 2026 premiums run from about R53 to about R1,150 per month, depending on plan, age and family size.
What is Gap Cover and how does it work?
When you are admitted to hospital, specialists such as surgeons, anaesthetists and physicians can charge more than your medical scheme pays. The scheme pays its own rate, and you are left with the difference. Gap Cover is the insurance that pays that difference for you.
Here is a simple example. Say a surgeon charges 300% of the medical scheme rate for a procedure. Your scheme pays its rate, which counts as 100%, and Gap Cover pays the 200% difference, up to the multiple your plan allows. On a R40,000 surgeon account where the scheme pays about R13,333, that leaves a shortfall of about R26,667. A plan that covers up to 500% of the scheme rate would settle that shortfall in full. For a deeper walk-through, see our complete guide to Gap Cover in South Africa.
Why is every Gap Cover policy capped at the same annual limit?
Gap Cover is a short-term insurance product, classed as an accident and health policy under the Demarcation Regulations that took effect on 1 April 2017. It is regulated by the Financial Sector Conduct Authority (FSCA), not by the Council for Medical Schemes, because it is not a medical scheme. National Treasury explains the policy background in its statement on the Demarcation Regulations.
The regulations set one overall annual limit for every policy: about R219,846 per insured person for the 2025/26 period, rising with inflation each 1 April. From 1 April 2026 the cap escalated again with CPI, which puts it at just over R220,000 per person per year. Because every provider works under the same ceiling, they compete on benefit structure, tariff shortfall multiples, waiting periods, entry age rules, sub-limits and price, not on exceeding that cap.
What does Gap Cover actually cover?
Gap Cover is built mainly around hospital events, with a smaller set of out-of-hospital benefits that differ from plan to plan. The three parts below explain what is usually included and what is not.
In-hospital shortfalls and co-payments
The core benefit pays the shortfall between the specialist account for an authorised admission and what your scheme pays at its rate. Most plans also cover the co-payments and deductibles your scheme applies to certain procedures, plus shortfalls on scheme sub-limits, oncology and accident casualty treatment.
What is a co-payment, and does Gap Cover pay it?
A co-payment, sometimes called a deductible, is a fixed amount your medical scheme makes you pay from your own pocket on certain admissions, scopes or scans, even when you are on a hospital plan. Common examples are a set co-payment on a gastroscopy or colonoscopy, or on an MRI or CT scan. Most Gap Cover plans refund these co-payments and deductibles, subject to the overall annual limit, which is one of the main reasons families take the cover.
In-hospital versus out-of-hospital Gap Cover
In-hospital cover is the heart of every plan and is broadly similar in what it aims to do. Out-of-hospital cover is narrower and varies more between providers. Where it exists, it usually applies to defined events rather than everyday care: co-payments on out-of-hospital MRI and CT scans, scopes such as a gastroscopy or colonoscopy, and oncology shortfalls, which are often treated outside a hospital. Gap Cover does not turn into day-to-day cover for GP visits, dentistry or medicine, which remain the job of your medical scheme or a medical savings account. It also does not pay amounts above the statutory annual limit, or anything at all for a person who is not on a registered medical scheme.
Why are more South Africans comparing Gap Cover providers?
Some medical disciplines charge well above medical scheme rates, in some cases up to 500% of the scheme rate, according to the Sanlam 2026 brochure. Analysis by COVER and Sirago Underwriting Managers shows that large shortfall claims have become more common as specialist fees outpace scheme tariffs. With what medical aid costs each month already stretching household budgets, a shortfall of tens of thousands of rand after one operation is a risk many families choose to insure.
How do the seven main Gap Cover providers compare in 2026?
The table gives the at-a-glance comparison. The sections after it add the detail on waiting periods, entry ages and price that the table cannot hold.
| Provider | Underwriter | Tariff shortfall cover | Entry age approach | A notable feature |
|---|---|---|---|---|
| Turnberry | Lombard Insurance | Up to 500% on higher plans; Launch up to 350% | Extended family added and priced up to age 80 plus | Complimentary international travel cover |
| TRA | Auto and General Insurance | Up to 700% on Absolute Cover Plus | Bands for individuals, families and over-65s | Entry pricing from about R99 per month |
| Sanlam Gap Cover | Centriq Insurance | Up to 600% on Comprehensive | Dependent children covered to age 27 | Large oncology benefit set with innovative medicines |
| Zestlife | Guardrisk | Up to 500% on Universal | No maximum entry age, no exit age | No general or condition-specific waiting periods |
| Stratum Benefits | Guardrisk | 300%, 400% and 500% plan options | No maximum entry age | 24/7 counselling and wellness service for 2026 |
| Discovery Gap Cover | Discovery Insure | Up to 500% on Comprehensive; Core 250%; Active 100% | Age-banded pricing with a 65 plus band | Automatic gap identification, no separate claim form |
| Sirago | GENRIC Insurance (Old Mutual Group) | Up to 500% on Ultimate Gap | No maximum entry age; cover does not cease at 65 | One family can span two different medical schemes |
What stands out about each provider?
Turnberry runs six plan tiers, from Launch at entry level through Med-Extend, Synergy, Dynamic and Optimal to Premier. Med-Extend pays up to 300% and adds a Defined Procedures Benefit that pays for some procedures a scheme excludes.
TRA (Total Risk Administrators) offers four plans, and Absolute Cover Plus pays up to 700% above the scheme tariff, a higher multiple than the other six providers. Travel insurance and value-added assistance services are included. Curemed distributes this same product line under its own brand as Curemed Gap Cover, with Basic 300, Vital Plus, Super Plus and Absolute Plus plans administered by TRA and underwritten by Auto & General Insurance Company Limited.
Sanlam Gap Cover offers Comprehensive and Core tiers plus an optional Mediclinic Extender, with Comprehensive paying up to 600%. Its oncology benefits include cover for innovative oncology medicines.
Zestlife offers Universal (up to 500%), Essential (up to 300%) and Optimal (up to 400%, available only to single individuals under 35). It also pays non-capped lump-sum benefits such as accidental death and a premium waiver.
Stratum Benefits names its plans by tariff tier: 300%, 400% and 500%. Some budget options are in-hospital only, so check the fine print if you want casualty or out-of-hospital linked benefits.
Discovery Gap Cover is available only to Discovery Health Medical Scheme members. The tight integration means the gap on a claim is identified automatically and members do not submit a separate claim form.
Sirago Underwriting Managers runs one of the broader plan menus, including Ultimate Gap at up to 500%, with premium waivers and oncology benefits. A family can stay on one policy even when members belong to two different medical schemes.
How do Gap Cover waiting periods differ?
Waiting periods are often the deciding factor between two similar plans, so it helps to check them against your own timing. Turnberry applies a 3-month general wait, waived on the shortfall benefit if the policy starts with the scheme, plus 10 months for pregnancy and 12 months for a listed set of conditions. Sanlam applies a 3-month general wait with accidents exempt, plus a 12-month pre-existing exclusion. Stratum applies a 3-month general wait and a 12-month pre-existing exclusion, and a listed set of procedures pays only 20% in the first 10 months.
Zestlife is the outlier, with no general and no condition-specific waiting periods, and only a 12-month pre-existing exclusion. If you expect a procedure soon, that difference matters more than a small saving on the premium.
How do Gap Cover entry age rules affect older applicants?
Entry age rules decide who can even take a plan, which is why older applicants should check them early. Zestlife sets no maximum entry age and no exit age, so cover can continue for life. Stratum sets no maximum entry age, and Sirago sets no maximum entry age with cover that does not cease at 65. TRA prices a band for over-65s so seniors can join, Discovery prices a 65 plus band, and Turnberry can add extended family members priced up to age 80 plus. For a retired parent, these rules can narrow seven options down to three or four very quickly.
How much does Gap Cover cost per month in 2026?
The figures below are approximate 2026 premiums that depend on age and family size, and they change every year, so treat them as indicative only:
- Turnberry: Launch about R185 per family (under 65); Premier about R737 per family (under 65).
- TRA: Basic from about R99; Absolute Cover Plus about R681 for an individual or family, about R846 for over-65s.
- Zestlife: Universal about R591 for an individual under 55; Essential about R429 for an individual under 55.
- Discovery: Comprehensive single from about R270; Core single from about R171; Active single from about R53.
- Sirago: Ultimate about R645 individual or R778 family (0 to 64); about R973 individual or R1,150 family (65 plus).
Sanlam Gap Cover and Stratum publish their own rate tables, so ask for a current quote rather than relying on outdated figures. Premium alone is a poor basis for a decision; read it alongside the multiple, the waiting periods and the plan you already hold when you compare medical aid plans.
How can a Curemed Advisor help you compare Gap Cover?
Curemed is an independent, FSCA-licensed brokerage (FSP 44098) that has operated since 1992 from Irene, Gauteng, serving clients in all nine provinces. Because Curemed is not tied to any insurer, an Advisor can compare Gap Cover providers side by side, check the waiting periods and entry age rules against your situation, and quote across the market. Curemed also distributes its own TRA-administered range, Curemed Gap Cover, which is weighed against the other providers in our overview of the best gap cover in South Africa. Premiums and exact benefits change each year, so it pays to confirm current figures before you sign. If you are still weighing your underlying scheme, read how to choose a medical aid first, then contact a Curemed Advisor for a personalised Gap Cover comparison and quote.
What do people ask when they compare Gap Cover?
What should I look at when I compare Gap Cover providers in South Africa?
Compare the tariff shortfall multiple, waiting periods, entry age rules, sub-limits such as co-payment and oncology benefits, and the monthly premium. Every policy carries the same statutory annual limit, so the differences sit in benefit structure and price.
How does Gap Cover work?
Gap Cover pays the difference between what a hospital specialist charges for an authorised admission and what your medical scheme pays at its rate, up to the multiple your plan allows. It works only alongside a registered medical scheme and pays out subject to the statutory annual limit.
What is the difference between in-hospital and out-of-hospital Gap Cover?
In-hospital cover pays specialist shortfalls and co-payments on authorised admissions and is the core of every plan. Out-of-hospital cover is narrower and varies by plan, usually covering defined items such as co-payments on out-of-hospital MRI and CT scans, scopes and oncology, not everyday GP or dental costs.
Does Gap Cover pay co-payments and deductibles?
Most Gap Cover plans refund the co-payments and deductibles your medical scheme charges on certain admissions, scopes and scans, subject to the overall annual limit. Check the plan schedule, because the list of covered co-payments differs between providers.
Which Gap Cover is right for me in South Africa?
No single policy suits everyone. All providers work under the same statutory annual limit, so the right choice depends on your age, your medical scheme, your budget and the procedures you are likely to need. An independent Advisor can compare quotes across providers for your situation.
Do all Gap Cover policies have waiting periods?
No. Many providers apply a 3-month general waiting period and a 12-month pre-existing condition exclusion, and some add pregnancy or procedure-specific waits. Zestlife applies no general and no condition-specific waiting periods, with only a 12-month pre-existing exclusion.
Is there a maximum entry age for Gap Cover?
It depends on the provider. Zestlife, Stratum and Sirago set no maximum entry age, TRA and Discovery price over-65 bands, and Turnberry can add extended family members priced up to age 80 plus.
How much does Gap Cover cost per month in 2026?
Indicative 2026 premiums range from about R53 per month for an entry-level single plan to about R1,150 per month for a family on a 65 plus band. Premiums depend on age, family size and plan tier, and they change each year, so confirm current figures before you buy.
