In this article, we outline some of the best gap cover plans and their prices in South Africa in 2022.
Gap cover plugs the gap between what medical aid schemes pay for and what healthcare providers charge. In this article, we cover the best:
- comprehensive gap cover
- gap cover for younger people
- value for money gap cover
- recommended gap cover for seniors.
Best comprehensive gap cover
Zestlife Universal Gap Cover provides comprehensive medical shortfall benefits at an affordable price. Claims are paid up to an overall annual limit of R182,700 per insured.
GP and specialist consultations, in and out of hospital, are covered at up to 500% of the medical scheme tariff. The day-to-day benefit is valid for more than 50 treatments.
Enhanced cancer cover, co-payment cover for CT, MRI and PET scans and hospital admissions, along with a non-network co-payment benefit ensure medical events, are paid in full.
Emergency-room cover, an in-hospital dentistry benefit and cover for robotic medical procedures are part of the Universal benefit structure.
Waiting periods are not unilaterally imposed and exclusions are limited. Zestlife policy holders have the option of extending existing cancer cover.
The monthly premiums for 2022 are as follows:
|
Individuals |
|
|
54 or younger |
R447 |
|
55 to 64 |
R566 |
|
65 and older |
R650 |
|
Families |
|
|
All under 65 |
R566 |
|
One or more over 65 |
R650 |
Best gap cover for the younger generation
Sirago Gap-Lite Cover is designed for young individuals and families. Medical aid shortfalls are covered at up to 250% of the scheme rate, based on an overall annual limit of R183,000 per person.
Benefits include limited co-payment cover for hospital admissions, scans, surgical procedures and the use of non-designated service providers. There’s basic cover for the treatments of PMBs at non-DSPs and procedures conducted in day hospitals or doctors’ rooms.
A cancer-boost benefit, newborn baby benefit, and emergency room and preventative care cover, are included on the policy.
The current monthly premiums for Sirago Gap-Lite are:
|
Individuals |
|
|
64 and younger |
R234 |
|
65 and older |
R339 |
|
Families |
|
|
All under 64 |
R339 |
|
One or more over 65 |
R386 |
Best value for money gap cover
Stratum Compact 300 is a comparatively low-cost option suitable for individuals and families. It covers common healthcare events, up to an overall annual limit of R177,838 per person.
The shortfall for in-hospital procedures is covered at up to 300% of the medical scheme rate. The benefit covers scopes, scans, radiology, pathology, physiotherapy, medication and certain dental procedures.
Beneficiaries have access to limited co-payment cover for the use of non-network healthcare providers. Casualty and trauma counselling cover, disability and death benefits, and top-up cancer cover, are part of the package.
In 2022, the premiums levied for Stratum Compact 300 gap cover are:
|
Individuals |
|
|
64 and younger |
R257 |
|
65 and older |
R490 |
|
Families |
|
|
All under 64 |
R311 |
|
One or more over 65 |
R490 |
Best Gap Cover for Seniors
Liberty Universal Gap offers extensive shortfall benefits for treatment and procedures conducted in and out of hospital. Claims are covered at 500% of the medical scheme rate, up to an annual overall limit of R182,700 per person.
Extensive co-payment cover includes a non-network benefit. A casualty ward and trauma counselling benefit, accidental death and permanent disability cover, and generous cancer, internal prosthesis, artificial joint and in-hospital dentistry benefits apply.
The monthly premiums for Liberty Universal Gap in 2022 are:
|
Individuals |
|
|
65 and older |
R650 |
|
55 to 64 |
R566 |
|
54 or younger |
R447 |
|
Families |
|
|
One or more over 65 |
R650 |
|
All under 65 |
R566 |
Gap cover from Discovery Health
Discovery Health offers gap cover to all members. Monthly premiums are dependent upon the current medical aid option a member is subscribed to. Non-Discovery Health members are excluded from cover.
Help in choosing the best gap cover plans
At IFC, we offer informed, objective advice about the best gap covers plans in South Africa and can assist you in joining the scheme that best suits your needs and budget.
Contact us for more information or to discuss your needs.
