Medical Gap Cover is Now Critical

Medical gap cover has never been this vital.

What exactly is medical gap cover? you ask.

Gap cover is that increasing large gap between what doctors, dentists, hospitals and other health providers charge and what your medical scheme is prepared to pay.

The fact that the Medical Schemes Act obliges medical aids to cover the costs of certain conditions (there are over 300 of these, including 26 chronic conditions) does not prevent the medical aids from unilaterally deciding what this means.

And most of them take it to mean they can cover these conditions up to a point and no further. The outstanding balance has to be paid by the patients.

It is a rare, and extremely expensive, medical aid plan that will indeed carry out the letter of the law. Most plans demand co-payments. Be warned: co-payment is another term for a payment gap.

There are several court cases under way at the moment where patients owe hundreds of thousands for heart operations or cancer treatments and are demanding that their medical schemes pay for this.


The payMedical Gap Cover Quotement problem is not getting better; it’s getting worse.

This is because the cost of specialist care, hospitalisation and many procedures is rising dramatically.

That’s because of the weak rand, a shortage of doctors and facilities and therefore high demand, but also because disease rates are skyrocketing.

The cost of medicine is a big worry. For instance, there is a single cancer pill that costs R25 000 per tablet.

Needless to say, if you unable to make your co-payments, then doctors, private hospitals, etc. will soon refuse to treat you any further and you will be shunted into the public health system where you probably will not want to be.

Your outstanding bills will be yours to pay if you survive to come out of a public hospital.


The short-term insurance industry has come up with a solution called gap cover. It is what it says it is: insurance to cover you in the event of heavy co-payments.

Needless to say the industry (yes, it is big business, not a charity) does not like the idea of this kind of insurance very much. They would prefer you to buy into a grander plan, even though it makes more sense to insure the gap.

Medical scheme members are buying into medical gap cover in a big way.

Ask your insurance broker about this type of insurance or get hold of one of the large insurance companies like Old Mutual or Sanlam to find out more about gap cover for your family.

Your phone call might save a life.


To get a gap cover quote go here

All info was correct at time of publishing