Planning for Gap Cover in South Africa

Planning for Gap Cover

It’s common knowledge that even the most comprehensive Medical schemes won’t cover you fully for every procedure, leaving many South African’s out-of-pocket at least a few thousand Rands, and sometimes much, much more. Even so, many people see Gap Cover as only necessary for those “what if” situations, like a rare dread disease, a medical emergency or unplanned hospitalisation.

With today’s increasing medical costs, and Medical Aids clamping down on what they will (and won’t) pay for, there are definitely some common situations you may need or want to plan ahead for, and find out that the only way you can pay for them is with the help of a comprehensive Gap Cover plan.

Based on the claims department data of our underwriters Turnberry, as well as our experience of more than 15 years in the industry below are some procedures you may be considering in the near future, which Gap Cover can help you cover financially should your Medical Aid not pay out in full:


If you are planning to have a child in the coming months or years, a good Gap Cover plan is essential. With more women opting to have a Caesarian section instead of natural childbirth, longer hospital stays and a recent lack of expertise in the field has pushed up the prices of childbirth dramatically. The fear of being sued and the cost of negligence insurance has resulted in many obstetricians leaving the childbirth delivery profession.The hospital and specialist costs of childbirth can also place a lot of pressure on families if there are complications, leading to an increase in the time of your hospital stay, extra procedures and more medical expertise being required.

Arthritis Surgery

Severe arthritis is a debilitating and common disease among South Africans. If you suffer from severe Arthritis, you will probably have to consider surgery as a form of treatment eventually. Gonoarthritis (osteoarthritis of the knee) is one of the most commonly claimed for ailments in Gap Cover, but unfortunately, many Medical Aids still require a co-payment for treatment. Don’t find yourself caught off-guard and with a hefty medical bill – invest in a comprehensive Gap Cover and ensure your surgery and treatment is covered.

Oncology Treatment

Cancer is a common dread disease and can place huge financial and emotional pressure on it’s victims and their families. Often requiring long-term treatment, costs often run way over what Medical Aids are prepared to pay. Breast Cancer itself is a common Gap Cover claim, with as much as 1 in 8 women affected. Requiring radiotherapy, chemotherapy, surgeries, mastectomies, skin grafts and reconstructions, once-off or monthly cancer treatment costs will in all likelihood experience a shortfall, requiring Gap Cover.

Dental Surgeries and Treatment

Many medical aids do not cover dental treatment fully, and these costs can add up quickly. If you’re planning and major dental work like removing your impacted wisdom teeth then a comprehensive Gap Cover plan will help ease the pain of medical scheme cover shortfalls, especially if you need to be placed under general anaesthetic and be admitted into a hospital for surgery.

Shoulder & Knee Surgery

Tendon and ligament injuries in the shoulder and knee are common injuries. South Africans are known for our high-impact sports participation like running, rugby, swimming and football, all of which can damage shoulders and knees quite easily. Both orthopaedic and anaesthetist bills normally cost up to 5 times more than what medical aids are prepared to pay, leaving patients with extreme financial pressure. If you have been struggling with one of these injuries for a while and are considering surgery or a specialists treatment, get a comprehensive Gap Cover sooner rather than later.

These common situations are often experienced at least once in our lives by ourselves or someone we know. It’s up to you to make sure that you have covered yourself against any medical scheme shortfalls when planning treatment. All new policies will be subject to waiting periods however, it therefore, remains your responsibility to ensure that you are aware of these and other exclusions that may apply to your cover.

CompliMed Gap Cover ensures that you and your loved ones are covered as much as possible through our comprehensive, simple and affordable Gap Cover solutions.