What is Gap Cover?

Type of Insurance: 

This is a Short-Term insurance accident and health policy regulated by the Financial Sector Conduct Authority (FSCA) and Prudential Authority (PA) under the auspices of the Short-Term Insurance Act 53 of 1998 and the Insurance Act 18 of 2017. 

What is Gap Cover? 

Gap cover is not a replacement for a medical scheme and the starting point for any gap cover claim is based on what the medical scheme paid, or not.  The claims actions of the medical scheme is the trigger event for gap cover.  As a basic insurance principle, Gap cover provides benefit for the difference between registered medical professional’s charged tariffs and the medical aid scheme rate for the benefit paid by your registered medical scheme. Gap Cover MAY NOT pay for shortfalls etc. where the medical scheme did not pay anything towards the cost of treatment.

Gap covers the difference between the provider and medical scheme payment provided that the medical scheme pays their Scheme rate. In instances where the medical scheme pays less than their scheme rate, we will defray the scheme rate from the charged amount.

Gap cover is a product that compliments your medical scheme option. 

The intention of Gap Cover: 

The intention of Gap cover is to place the policy holder back into the same financial position that they were in before the procedure was performed. 

Gap cover options are made to compliment the policy holders chosen medical aid option.