What Is Covered Under A GAP Cover Policy?

A GAP cover policy is designed for members who belong to a medical aid society already. It covers shortfalls in hospital cover where surgeons, anesthetists, scanning specialists and other in-hospital procedure personnel charge more than medical aid rates.

In most instances, and depending on the medical aid you are with, you are left with bills that you never thought you’d have to cover. Medical aid will only cover a certain amount, and there is an amount over which you must come up with.


Medical insurance providers offer special service packages, such as day-to-day cover, hospital-only cover and comprehensive cover. You can choose which package suits your budget and needs.

Read the fine print!

This sounds terrific, but there are anomalies. Medical specialists assume everyone has GAP cover, so they sometimes charge exorbitant fees, knowing that GAP cover will take care of the shortfall. These days, many GAP cover providers have worked out a new way of how much of the co-payment they will pay.

It’s pretty much all based on what your medical aid pays and how much they’ve calculated to cover GAP costs. So, they don’t automatically pay everything owing. It is up to your medical aid scheme to figure out just how much they will pay. This, by the way, is all in the fine print, so it’s up to you to get stuck in and read it all.

Some of the things GAP cover won’t cover are:

  • In-hospital stays (check with medical aid).
  • Medication.
  • Certain medical examinations like ultrasounds.
  • Home care.
  • Transportation costs.
  • Dental treatment at private surgeries.
  • Cosmetic procedures.

The plan can vary from one insurer to another. Best you check with the insurer as to what has been added (or removed) from the list.

What GAP may also cover, surprisingly:

  • Some out of hospital procedures that can now be done in a doctor’s rooms.
  • Hip replacement procedures, up to a certain limit.
  • Contributions to cancer treatment once your cancer package on your medical aid has expired.
  • A complete package for first-time cancer diagnosis.
  • Lump sum benefit for accidental death or total disability.
  • Long-term hospitalisation lump sum.
  • Certain casualty costs.

Check yet again to see if anything has been added or removed.

It’s worth taking out

So, is it worth it? We say that it is. You never know what curve ball life is going to throw at you, and especially with chronic conditions such as cancer, it is most definitely worth the regular monthly payment.

Just keep in mind that with cancer, once your cancer package has run out from your medical aid, you must wait for a year for that GAP cover to kick in for the same condition. So, if your cancer treatment has run its course and you’re in remission, you will have to wait a year from the time you took out GAP cover for it to be used again for cancer treatment if that condition should return.

This applies to any chronic condition that you had already, so check with an insurer just what your situation is.