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What is Gap Insurance & why is it so valuable to have?

When you are in the process of selecting a medical aid, the question of adding gap cover to your plan is likely to come up. More than 1 million South African families understand the importance of gap cover, which is why they have opted in. But should you? First things first…

What is gap cover?

Gap cover is provided to cover the shortfall of medical expenses. For instance, if you are hospitalised or treated for a condition and a specialist not covered in your medical aid plan is needed to carry out the procedure, gap cover will be able to cover some or all of the costs (depending on the type of gap cover you have) not covered by your medical plan.

What does gap cover include?

Similar to medical aid plans, gap cover can vary significantly depending on the gap cover you choose, as well as the company that you choose your gap cover with. We strongly suggest choosing a gap cover with a reputable company. Gap cover could include shortfalls on in-and-out-of-hospital specialist claims and treatments, certain medical expenses when travelling abroad, partial cover for certain wellness tests and cover on specific cancer-related claims. Some of the better gap covers of lump-sum payouts to assist with additional expenses as well as home support.

Is gap cover important?

Gap cover is really important to supplement your medical aid. In our opinion, the two go hand-in-hand. Your medical aid might cover part of certain medical costs, in which case gap cover will be able to bridge the gap between the expenses covered by your medical aid and the expenses that will need to be covered out of your pocket.

Why should I get gap cover?

Life-threatening medical conditions come with a huge price tag. On top of dealing with the ailment itself, one shouldn’t have to worry about the financial burden too, but in reality that isn’t the case. On average, specialists cost three times the amount covered by medical aid, which means that your medical aid will only cover a third of the cost incurred by a specialist, leaving you with a shortfall.

5 of the most common gap cover claims made in 2019 provided by one of the leading Gap Cover providers:


To illustrate, here are the five largest Zestlife Gap Cover claims paid in 2019.  

*(Source: Zestlife claims statistics 2019)

As you can see, gap cover is an essential part of your medical aid as unexpected expenses may arise. It is best to cover all of your bases to ensure that you and your family are fully covered should you require medical care.

If you’re still are interested in finding out more about Gap Cover, talk to an Advisor or sign up with Zestlife today.  


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