Co-Payment Cover

Co-payment cover, also called CoPay cover, is insurance that covers part or all of the cost of co-payments to your medical aid scheme.

A co-payment is a fixed amount that your medical aid scheme requires you to pay from your own pocket for a specific medical treatment or procedure. Co-payments are typically for in-hospital procedures.

With increasing private healthcare costs, co-payments have become larger and more common. They can leave medical aid members significantly out of pocket.

Co-pay cover providers in South Africa

The following providers include co-payment cover, subject to stated limits, as part of certain gap cover plans.

Sirago also offers co-pay cover together with its Exact insurance, which provides cover of fixed amounts for medical procedures not covered by your medical aid scheme.

Co-payment cover and gap cover

Gap cover often includes co-payment cover, up to specified limits.

However, co-payment cover and gap cover aren’t quite the same. Some insurers offer them as separate products, or separate add-ons to particular types of health insurance.

So what’s the difference?

Co-payment cover is paid out only if your medical aid scheme requires you to make a co-payment.

Gap cover is broader. It’s any insurance designed to cover shortfalls between what medical aid schemes will pay and what healthcare providers actually charge.

For example, it may include specific benefits for emergency room treatment, or for procedures at healthcare providers that aren’t part of your medical aid scheme’s network. It often includes cover for the “gap” portion of hospital accounts. It may also include some cover for out-of-hospital procedures.

Both gap cover and co-payment cover are available only to medical aid scheme members.