What is Gap Cover in South Africa?

Gap Cover is a type of insurance that covers the shortfall between what your medical aid pays and the actual costs of hospital treatments and procedures. It includes co-payments your medical aid may impose.

Gap Cover is essential for anyone with medical aid, as it protects against unexpected in-hospital medical expenses that your plan may not fully cover.

Does Gap Cover include co-payments?

Yes, most Gap Cover plans include benefits for co-payments on specialist visits, surgeries, and other medical treatments.

How do I apply for Gap Cover?

You can apply for Gap Cover by filling out and submitting an online application on https://bestmedicalaid.co.za

A Gap/Top Up pays in-hospital shortfalls and procedure co-payments

Home: bestmedicalaid.co.za

Have you ever had hospital bills short-paid?
Or a co-payment charged for a specific treatment or procedure?

Private doctors and specialists can charge what they want, often up to 5 times what your medical aid pays!
Medical aids are increasingly charging co-payment for expensive procedures.
Procedures like knee replacement surgery, colonoscopies, or using hospitals outside of your medical aid’s network.

The only way to address the threat of you having to pay these high medical expenses is to join a Gap and CoPay plan today.

Many medical aid members have already done this and are stress-free medical aid members.

The Agility Gap & CoPay Cover gives you:

More in-hospital medical cover (up to 500% of medical aid rate payments), without needing to upgrade your current medical aid.
Pays the penalty if you use non-network hospitals
Unlimited cover for procedural co-payments across all the options
Extensive medical emergency cover
Maternity cover
PMB cover
Gap and medical scheme premium waiver benefits
A Hospital Booster Benefit (which covers private room upgrades, in-hospital sub-limits & robotic-assisted surgery)

Through a variety of cover levels, Agility offers you a choice of options to best suit your needs and budget.

comprehensive medical aid gap and top up There are 2 main options:

1. The Agility Range of comprehensive, highly specialised mediocal aid shortfall cover plans are suitable for all budgets.
Guaranteed to cover the difference between your medical scheme rate and what your doctor or hospital charges for an in-hospital procedure.
There is a choice of 200% to 500% cover for in-hospital specialist fee shortfalls, exceeding your medical aid’s limits.

2. The Agility Combined Range of integrated Gap and CoPay benefits.
Covers benefit shortfalls, where your doctor or hospital charges more for an in-hospital procedure than what your medical scheme will cover, as well as any out-of-pocket contributions that you may need to pay towards an in-hospital procedure.

They include full cover for in-hospital professional fee short payments, co-payments related to MRI & CT scans, as well as procedural admissions to hospital across a range of 200%, 400% & 500% of medical aid rates.

The Combined 400, Combined 500 and Ultra options include cover for in-hospital sub-limits, robotic-assisted shortfalls and private room upgrades.

Other benefits are:

Oncology Shortfall Benefit
Premature Birth Cover
Extensive out-patient cover including emergency room benefits, physiotherapy consultations and more
Procedures performed as an in-patient or as an out-patient (specified list of procedures), as well as MRI, CT, and Ultrasound scans.
Outpatient Benefits - Comprehensive cover for out-of-hospital in-room procedures, consultations, including GP, Specialist, Dentist, Physio & Psychology Consultations
Maternity benefits during pregnancy - Lump-sum benefit activated after first trimester, 2D, 3D, 4D Scans (in-and-out-of-hospital)
Emergency Room Benefit - covers all beneficiaries on the policy without age limitations or reasons for emergency visits. All treatments and consultations for Trauma, Accident & Illness will be covered up to the annual benefit per policy, regardless of any payment by the medical aid.
Trauma Counselling Benefit - Cover in the event of an unplanned traumatic incident, including accidents or events of violence leading to physical injury or psychological trauma. This benefit provides consultations with registered psychologists, psychiatrists, or counsellors.

cura gap benefits

No medical aid member can afford to be without Gap/Top up cover.

How to Choose a Medical Aid

Agility Gap Application

Talk to me .... I am here to help you - at no charge!
Send me your questions and concerns. I'll answer them for you.

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?

YOUR TRUSTED, QUALIFIED ADVISOR:
Peter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991.
Death, Disability, Retirement, Investment, Healthcare and Estate Planning.
FSP Licence 2995 and Medical Aid Accreditation BR 7428
Based in Sandton.
FSP Licence 2995 and Medical Aid Accreditation BR 7428
Based in Sandton.

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Last update: April 15, 2025