What Is GAP Cover And How Do I Qualify?

GAP cover is an added medical aid product that can be used in the event of additional costs for a hospital procedure or emergency surgery.

There are four vital points to remember with GAP cover.

  • It can only be taken out if you belong to a medical aid already.
  • It can only be used for in-hospital procedures.
  • There is a three-month waiting period before GAP cover kicks in.
  • If your add-to medical aid package, for instance, an additional package to your medical aid for cancer, has been exhausted, you must wait 12 months for your GAP cover funds to be used specifically for that condition.



Some medical aid consultants have incorrectly told members that should they need GAP cover it can be taken out immediately should you suddenly need to pay additional costs. As can be seen from the above bullet points, GAP cover doesn’t work like that.

It should be noted that medical aids may differ in their applications for GAP cover, and you would do well to consult your fund regarding additional rules that could apply.

Numerous packages

There are numerous packages that can be taken out regarding GAP cover, much the same as choosing a package for medical aid. Each offers a different amount that can be used in times of shortfall of costs.

Basically, GAP cover is being able to make up the difference what a medical specialist will charge for in-hospital procedures and is covered by medical aid, and what amount is left for an additional payment.

Unexpected medical costs are a feature of daily life anywhere in the world and having GAP cover available is a definite boon, offering peace of mind for a relatively small monthly payment.

The popularity of GAP cover has proved the necessity of the cover. Many hospitals and specialists have been found to charge excessively, many times more than the medical aid rates. This has left many patients in dire need of having to come up with extra money to cover the remainder of the bill after the medical aid fund has paid its portion.

Adding to the patient’s stress

A couple of years ago, many patients were unaware of GAP cover mainly due to the fact it wasn’t publicised much – a point that the medical aids should be held accountable for.

These patients found themselves having to take out loans to pay for the additional amount. Many were also refused loans by banks, adding to the stress that their medical conditions had placed upon them.

It was an untenable situation, leading to the emergence of GAP cover. Many consumers, though, are still unaware what GAP cover will pay for. This is why the policies should be studied carefully, and the fine print gone through thoroughly. When in doubt, it would be prudent to discuss everything with the medical aid concerned.

It would be good to remember that GAP cover will only pay for a shortfall of a condition already covered by the medical aid. If the fund would not sanction a procedure initially then the GAP cover would not be able to help.