You should never assume that your medical scheme will cover the full cost for operations and procedures done in the hospital. Medical Schemes pay doctors and specialists at a rate of between 100% and 300%, but the reality is that many medical practitioners charge in excess of these rates which could result in a gap between the actual cost and the amount that the medical schemes pay. You will be held liable for the shortfall.

Furthermore, medical schemes may impose upfront co-payments for certain in-and-out of hospital procedures, depending on your medical scheme option, these co-payments are either payable from your medical savings account or as an out-of-pocket expense.

    WHAT ARE THE ADVANTAGES?

    • Our products are compatible with all registered South African medical schemes
    • Our gap cover products enhance medical scheme benefits
    • An additional gap benefit of 500% above the medical scheme rate is provided
    • Certain options provide additional cover for co-payments, including out-patient MRI- and CT-scans, enhanced benefits for certain in-hospital sub-limits and additional oncology benefits.
    • Gap cover is not designed to assist with day-to-day cover, however, it assists with major in-hospital medical expenses.
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