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Close the gap, with our comprehensive cover
Gap cover offers you extra protection, covering the shortfall of your medical aid.
What is Gap Cover?
Gap cover is a short-term insurance product designed to fill the shortfalls left by medical aid schemes. It plays a crucial role in the country’s healthcare landscape because it helps individuals and families manage the rising costs of medical treatments and hospitalisation.
We have partnered with TRA to provide you with the best Gap Cover offering. While private healthcare offers superior services, it can be expensive. Gap cover is essential as it assists in covering the shortfall between what medical aids pay and the actual cost of medical procedures, specialist fees, and hospital stays. This ensures that you can access quality healthcare without the burden of excessive out-of-pocket expenses, making it an invaluable safeguard for your financial well-being.
Our Gap Cover options
GAP COVER UP TO 300%
CASUALTY UNIT BENEFIT
ONCOLOGY BENEFITS
CUREMED BASIC 300
GAP COVER UP TO 700%
CASUALTY UNIT BENEFIT
ONCOLOGY BENEFITS
CO-PAYMENT BENEFIT (IN NETWORK)
SUB-LIMIT BENEFIT: INTERNAL PROSTHESIS
CUREMED VITAL PLUS
GAP COVER UP TO 700%
CASUALTY UNIT BENEFIT
ONCOLOGY BENEFITS
CO-PAYMENT BENEFIT (IN NETWORK)
SUB-LIMIT BENEFIT: INTERNAL PROSTHESIS
CUREMED SUPER PLUS
GAP COVER UP TO 700%
CASUALTY UNIT BENEFIT
ONCOLOGY BENEFITS
CO-PAYMENT BENEFIT
SUB-LIMIT BENEFIT
CUREMED ABSOLUTE PLUS
Gap Cover Benefits
Home Drive
A designated driver service including “Own Vehicle” OR “Uber” services. 6 trips per policy per annum. Limited to
a 50km radius.
Panic Button
24-hour access to a crisis manager who will guide and assist you through an emergency.
Travel Benefit
Some of the benefits include:
Medical evacuation, repatriation or transportation to a medical centre – FULL COST covered when arranged by
Hepstar Financial Services.
Inconvenience Cover: Baggage Cover: R5 000 for theft, damage or loss by travel supplier
TRA Mobile App
Submit claims directly via the mobile app. Click below to download the TRA Assist app now:
Personal Health Advisor specialising in Gap Cover
Our team of experienced advisors is dedicated to your well-being, providing personalised guidance and support every step of the way.
Expert Gap Claims Support
No more time or money wasted on your claims! With our expert team of Gap Cover Claims Specialists, you can rest easy knowing your claims are in the right hands.
Our team is here to provide the support you need. Our compassionate and highly trained counsellors are just a phone call away.
24 Hour Health Advice
24/7 Admin Assistance
24/7 access to a servicing team who know all the ins and outs of handling Gap Cover queries.
Try our Gap Cover calculator
Our gap cover calculator is a powerful tool designed to help you understand and manage your healthcare expenses more effectively. By simply inputting your medical scheme details and coverage information, the calculator can quickly assess any potential gaps in your healthcare coverage. It provides you with valuable insights into potential out-of-pocket expenses and offers tailored suggestions to bridge those medical shortfalls. With our gap cover calculator, you can make informed decisions about your medical aid, ensuring that you and your loved ones receive the care you need without unexpected financial burdens. It’s a valuable resource for you to take control of their healthcare finances.
Frequently asked questions about gap cover
What is gap cover and why might I need it?
Gap cover is a short-term insurance product (regulated under the Insurance Act, not the Medical Schemes Act) that pays the difference between what your medical aid scheme covers and what private specialists actually charge for in-hospital treatment. Medical schemes typically pay at the scheme rate; specialists often charge above that. Gap cover bridges that shortfall, reducing your out-of-pocket exposure.
Is gap cover a medical aid?
No. Gap cover is short-term insurance, not a medical aid scheme. It cannot replace medical aid - it only supplements it. To buy gap cover you must already belong to a registered South African medical scheme. The two products are regulated by different authorities (FSCA for insurance, CMS for medical schemes).
Are there limits on gap cover payouts?
Yes. South African law caps the total annual gap cover payout per insured life (the limit is set by the Demarcation Regulations and adjusted periodically). Within that annual cap, individual benefits are also defined per gap cover policy. Different gap cover insurers offer different sub-limits for sub-benefits like co-payments, MRI/CT scans, oncology, and cancer treatment.
Does gap cover cover hospital co-payments?
Most gap cover policies include cover for hospital admission co-payments and procedure-specific co-payments (e.g. MRI scans, joint replacements, scopes). The exact list of co-payments covered depends on the insurer and the gap cover product chosen. Some products also offer cover for excess premiums on chronic medicine and oncology benefits.
When can I buy gap cover and are there waiting periods?
You can buy gap cover at any time provided you have an active medical aid plan. Most products have a general 3-month waiting period for new claims and condition-specific waiting periods of up to 12 months for pre-existing conditions. Some insurers waive waiting periods when you switch from one gap cover product to another without a break.