Medical Gap Cover

Medical gap cover helps pay hospital bills that aren't fully covered by your medical aid in South Africa. It's not a medical aid but rather insurance that covers you in the event that your medical aid doesn't cover all your costs.

Medical service providers, like doctors, can charge an average of 5 times (or 500%) the medical aid rate, leaving you to pay the difference out of pocket. They may also request certain procedures and scopes, such as an MRI and gastroscopy, which would require a co-payment.

With Old Mutual Gap Cover, it costs as little as R186.62 per family, per month for up to R150 000 cover per beneficiary, per year. If a family member over the age of 60 is included on the policy, the policy premium will be R242.11 per month.

361x219_GAP_Diagram
 

NEED HELP?   CALL 0860 665 463 or   LIVE CHAT

 
 

CALL ME BACK

I want:
By completing this form you consent to a credit score Consent to marketing
Medical Scheme Cover
Medical Gap Cover
Thank you.

A consultant will contact you shortly.
Please note our working hours are 08:00 to 17:00 weekdays.
 

CAN YOU AFFORD NOT TO HAVE GAP COVER?

 
 

WHAT ARE THE BENEFITS

 
 

WHAT AM I COVERED FOR

The total cover amount is R150 000 per beneficiary, per year. This annual limit includes in-hospital costs, as well as some out-of-hospital costs.

Income Protection-02

How does gap cover work?

Medical aid gap cover helps you pay the shortfall on those medical expenses not fully covered by your medical aid.

The shortfall on those medical expenses are often not fully covered by your medical aid. Doctors can charge up to 5 times medical aid rates, and some specialist procedures require a co-payment, which your medical aid might not cover in full. This means that you will need to pay the difference, the gap, out of pocket.

Cash 4 loved ones-02

What does gap cover pay for?

Gap cover pays for in-hospital and out-of-hospital medical expenses that are not fully covered by your medical aid.

You receive a total cover amount per person, per year, so that if you are admitted to hospital or have to go for tests or procedures out-of-hospital, you will be able to pay the costs not covered by your medical aid.

 GAP_InHospital_icon

The in-hospital costs included in my cover?

All in-hospital claims are deducted from the overall R150 000 annual limit.

Tariff shortfalls
  • Up to 500% of medical aid rate.
Co-payments and deductibles
  • Includes MRI, CT, PET, SPECT and ultrasound scans.
  • Limited to certain diagnostic and medical procedures/treatment such as gastroscopies and colonoscopies.
  • Non-designated hospital co-payment limited to R12 000 per family, per annum.
Shortfalls from sub-limits
  • A maximum compensation limit of R40 000 per policy, per annum.
Oncology
  • A maximum compensation limit of R150 000 per beneficiary, per annum.
Dental surgery
  • A maximum of R5 000 per beneficiary, per annum for tariff shortfall cover and R5 000 per beneficiary for co-payment and deductible cover, for impacted wisdom teeth removal.
 GAP_OutHospital_icon

The out-of-hospital costs included in my cover

All out-of-hospital claims are deducted from the overall R150 000 annual limit.

Tariff Shortfalls
  • Up to 300% of medical aid rate for out-patient procedures, limited to 2 claims per beneficiary, per annum.
Physical Trauma
  • Casualty ward benefit related to a physical trauma event, limited to R5 000 per family, per annum.
External Appliance Benefit
  • Up to a maximum of R2 000 per annum for appliances such as crutches, knee braces, arm slings and moon boots.

Frequently Asked Questions

Want to know more about Gap Cover? Get answers to frequently asked questions such as:

  • Is it possible to get Gap Cover with no waiting period?
  • How to claim?

Visit Frequently Asked Questions.

 
 

CALL ME BACK

I want:
By completing this form you consent to a credit score Consent to marketing
Medical Scheme Cover
Medical Gap Cover
Thank you.

A consultant will contact you shortly.
Please note our working hours are 08:00 to 17:00 weekdays.
 
 

 

Gap Cover is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership. Premium is risk profile dependent based on customer’s age.

Old Mutual Gap Cover is a product underwritten by Old Mutual Insure Limited (Authorised Services Provider), and administered by Insuremed Administrators (Pty) Ltd.