The Best Gap/Top-up plan.
The right cover for your needs and budget
Are you worried that your medical aid will short-pay in hospital claims?
Most medical aid plans in South Africa do not pay in hospital claims fully.
Medical aids are also imposing procedure co payments, sub-limits, and cancer treatment shortfalls.
Many people assume that their medical aid will cover all their medical costs, but this is seldom if ever the case.
Designed to enhance your current medical aid benefits, Cura Gap/Top plans pay in-hospital (and certain out-of-hospital) claim shortfalls that may arise when healthcare providers charge higher fees than what your medical aid pays.
You also have cover for medical aid co-payments, sub-limits, and cancer treatment shortfalls, with some plans will pay up to 6 times the medical schemes tariff.
Examples of Gap Cover claims:
- Heart Surgery Specialists Shortfalls: R 120,000
- Brain Surgery Specialists Shortfalls: R 75,126
- Spinal Surgery Specialists Shortfalls: R 116,222
You can prevent either of these threats affecting your possible hospitalisation costs by joining one of Cura Administrators 7 affordable Gap/top up plan options.
Gap Cover Explained
A gap cover is not a medical aid scheme. It is a separate insurance that will help you meet most in-hospital shortfalls your medical aid may have.It can only provide benefits if your medical aid offers them.
Cura Gap cover plans provides cover for all prescribed minimum benefits (PMBs), in-hospital co-payments and deductibles, shortfalls on consumables, casualty benefits, and trauma counselling.
The higher plans also offer out-of-hospital benefits like radiology and pathology, specialist consultations etc.
This comprehensive coverage helps ensure that you are protected against various healthcare expenses not fully covered by your medical aid scheme.
Gap Cover Options
There are 7 different gap cover options, to provide you with the right cover at the right price.
1. Student Cover
For those aged 18 and 27, who have become too old to stay on their parent’s medical aid and are students or do not qualify as a student or are not permanently employed. Benefits mainly cover in-hospital costs with additional, extensive cover for those unplanned medical emergencies.Includes a casualty benefit and accidental or cancer-related dental benefit and offers cover up to 400% of the medical scheme rate.
Premium R 200 pm.
2. Basic Gap Plan
For young individuals or newly-weds it offers essential benefits covering medical expense shortfalls like technologists, Midwives, GP’s, Specialists, and PMBs up to 400% of medical aid rates. It includes benefits for casualty co-payments.Single Premiums: Younger than 65 - R 220 pm
Over 65 – R 340 pm
Family Premiums: Younger than 65 - R 340 pm
Over 65 – R 515 pm
3. Standard Gap Plan
For young families planning or with newborn children. It extends the Basic Plan to include in and out of hospital co-payments including a medical aid premium waiver, casualty, trauma counselling, and a consumables benefit, up to 500% of medical aid rates. Includes a medical scheme premium waiver.Single Premiums: Younger than 65 - R 345 pm
Over 65 – R 530 pm
Family Premiums: Younger than 65 - R 530 pm
Over 65 – R 730 pm
4. Advanced Gap Plan
For middle-aged families with teen children, it extends the Standard plan to include the use of non-DSP hospital co-payments, in-hospital sub-limits, sub-limits on intra ocular lenses, and cancer treatment (excludes specialist’s consultations).Cover for the most common types of claims and medical expense shortfalls, up to 500% of medical aid rates. International travel Insurance, pathology, and radiology once medical aid savings and/or day-to-day benefits are depleted.
It includes mastectomy benefits, non-listed biological cancer drugs, and co-payments on Rheumatoid Arthritis biological medication. Includes medical aid and gap plan premium waiver.
Single Premiums: Younger than 65 - R 480 pm
Over 65 – R 561 pm
Family Premiums: Younger than 65 - R 561 pm
Over 65 – R 760 pm
5. Advanced Gap Plus Plan
The most popular plan has all the Advanced plan benefits and more...For middle-aged families with teen children, who require more comprehensive benefits. It ensures cover for most common type claims up to 500% of medical aid rates.
Single Premiums: Younger than 65 - R 525 pm
Over 65 – R 615 pm
Family Premiums: Younger than 65 - R 615 pm
Over 65 – R 850 pm
6. Ultimate Gap Plan
Niche benefits for more mature members needing even more comprehensive cover and increased limits per person, up to 600% of medical aid rates.Provides lump sum cancer diagnosis benefit, international travel insurance,
Death or Total and Permanent Disability premium waiver, and an Accidental Death Benefit. Out of hospital MRI and CT scans, non-DSP hospital co-payments, internal prosthesis, intra ocular, in-hospital sub-limits, pathology and radiology, cancer co-payment, in-hospital consumables, casualty, trauma, acute or step-down facility for rehabilitation treatment.
It includes mastectomy benefits, non-listed biological cancer drugs, and co-payments on Rheumatoid Arthritis biological medication robotic assisted surgery co-payments, and private room cover. Includes medical aid and gap plan premium waiver.
Single Premiums: Younger than 65 - R 680 pm
Over 65 – R 800 pm
Family Premiums: Younger than 65 - R 800 pm
Over 65 – R 1,105 pm
7. Ultimate Gap Plan Plus
The best and most comprehensive plan, with a vast range of benefits over and above the Ultimate plan. Up to 700% of medical aid rates.Single Premiums: Younger than 65 - R 750 pm
Over 65 – R 905 pm
Family Premiums: Younger than 65 - R 905 pm
Over 65 – R 1,190 pm
Maximum limits are R 210,850 per person, per year.
See the full benefits and limits here ...
Cancer Cover
One in four South Africans may present with cancer. It results in enormous stress, emotions and a financial burden. Cancer patients need to focus on the healing process and not the high costs treatment. This policy addresses these unexpected medical costs.
- R100 000 stated benefit per lifetime per insured
- Must be diagnosed whilst on cover and alive.
- Excludes any skin cancer
- R201 000 for shortfalls on out-patient oncology treatment per insured per annum.
- R3 000 combined benefit for both registered psychology and psychiatric treatment.
- Max entry age 64 last.
- Premiums R 255 pm
Please ensure you understand the products.
It is important to note that this product is specifically designed to help you meet the private tariffs charged by doctors, anaesthetists, radiologists, physiotherapists, and specialist surgeons, for in-patient treatment. It does not cover the actual cost of the hospitalisation. no benefits are payable for a period of 12 months from the start date of cover in respect of medical conditions, for which in the 12 months before the start date of the cover, medical advice, diagnosis, care, or treatment was received or would reasonably have been recommended. Exclusions do apply. Terms and conditions do apply.
What Gap Cover Doesn't Include
Gap plans do not cover day-to-day medical expenses.Additionally, if your medical aid would have never covered a specific claim, the gap plan will not provide benefits either.
Gap Cover is not a medical aid plan, nor a substitute for medical aid.
It is an insurance policy, providing cover for claims that your medical aid does not fully pay for.
A claim must have been paid by a medical aid before a gap claim will qualify for payment.
If you have medical aid, you should have Gap Cover to complement it.
It is your best solution to protect you from in-hospital medical aid claim shortfalls.
Cura Gap Application
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The plan works with any medical aid!
Enhance your cover without having to change from your medical scheme!
You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
083 655 2164
Medical aid pays healthcare costs.
What if a disability stops your income?
Peter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991. Death and Disability Planning; Retirement Planning; Investment Planning; Healthcare and Estate Planning.
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Last update: January 18, 2025