
Ever felt a pit in your stomach after a hospital visit, even with medical aid?
Medical aid is supposed to be your knight in shining armour, protecting you from the financial blows of illness or accidents. But sometimes, that armour feels a little too light. This is because medical aid often sets rates for procedures and specialists, and if the actual cost is higher, you’re left footing the bill – a nasty surprise on top of whatever brought you to the hospital in the first place.
Here’s where gap cover steps in. It acts like a superhero’s trusty sidekick, leaping in to bridge the gap between what your medical aid pays and the real cost of treatment. With gap cover, you can focus on getting better, not stressing about surprise medical bills.
Gap Cover: Your Medical Aid’s Super Sidekick
Imagine this: you have medical aid, a safety net for unexpected medical expenses. But then comes a hospital visit, and relief turns to worry. The bill arrives, and it’s significantly higher than what your medical aid covered. Why?
Here’s the rub: medical aid sets rates for procedures and specialists. These rates are great, but sometimes, reality doesn’t quite match the plan. Specialists, especially for critical procedures, often charge more than the approved medical aid rate. This difference leaves you with a gap – a potentially substantial out-of-pocket expense.
This is where gap cover swoops in, acting as your medical aid’s super sidekick. It’s a specific type of insurance designed to bridge this gap between medical aid rates and specialist charges.
Think of it like this: medical aid pays a portion of the bill based on their pre-determined rates. Gap cover then jumps in to cover the remaining amount, up to a specified limit in your policy, ensuring you’re not left with a hefty surprise bill.

How Gap Cover Saves the Day: A Step-by-Step Breakdown
Imagine you need surgery. Here’s how gap cover tackles the potential financial villain lurking in the shadows:
Doctor Charge: The surgeon performing your surgery sets their fee, which might be higher than the rate your medical aid approves. Let’s say the surgeon charges R100,000.
Medical Aid Steps Up: Your medical aid, based on their plan, agrees to pay a pre-determined rate for the surgery, say R70,000. This leaves a gap of R30,000.
Gap Cover Enters the Ring: Here’s where your gap cover policy shines. It kicks in to cover the difference between the medical aid’s contribution (R70,000) and the actual doctor’s charge (R100,000). However, it’s important to remember that gap cover policies typically have limits. Let’s assume your gap cover has a limit of 100% of the medical aid rate. In this case, it would cover the entire R30,000 gap.
Voila! You’re left with a manageable amount (depending on your specific plan) to pay, instead of the full R30,000 burden. This allows you to focus on recovery, not scrambling for finances.
Key Points to Remember:
- Gap cover pays the difference up to a limit, so it’s crucial to choose a plan with a limit that suits your needs.
- Not all gap cover policies are created equal. Some might have sub-limits for specific procedures, so be sure to read the fine print.
Gap Cover: Your Targeted Shield Against Medical Expense Gaps
While gap cover can’t replace your trusty medical aid, it acts as a targeted shield against specific shortfalls. Here’s what it typically covers:
In-Hospital Specialist Charges: Remember how we mentioned specialists often charge more than medical aid rates? Gap cover steps in to bridge this gap, ensuring you’re not left paying a hefty sum for in-hospital specialist services.
Beyond the Hospital Walls (For Some Policies): Some gap cover policies extend their reach beyond in-hospital care. They might cover specific out-of-hospital procedures, like oncology treatments or scans, depending on the plan you choose.
Important Considerations:
Not a Replacement: Gap cover complements your medical aid, not replace it. You’ll still need a medical aid policy to be eligible for gap cover.
Know Your Limits: Gap cover policies typically have limits on how much they’ll cover for each claim. These limits can be a percentage of the medical aid rate (e.g., 100%) or a set rand amount. Choose a plan with limits that align with your needs and risk tolerance.
Read the Fine Print: Not all gap cover policies are created equal. Some may have sub-limits for specific procedures, exclusions for certain conditions, or waiting periods before coverage kicks in. Make sure you understand the details of your policy before signing up.

Benefits of Having Gap Cover
Let’s face it, medical emergencies are stressful enough. The last thing you need is the added burden of worrying about surprise medical bills. Here’s where gap cover shines, offering a range of benefits that empower you during challenging times:
Peace of Mind: Medical bills can be a major source of stress, especially during recovery. Gap cover offers peace of mind by knowing you’re protected from unexpected out-of-pocket expenses. You can focus on getting better, not scrambling for finances.
Financial Freedom: Gap cover acts as a financial safety net. It helps bridge the gap between medical aid coverage and the actual cost of treatment, freeing you from the burden of potentially hefty bills. This allows you to prioritize your health and well-being without the financial strain.
Choice and Control (Within Limits): With gap cover, you potentially have more freedom to choose the specialist you need, regardless of their rates (up to your gap cover limit). This can be crucial when seeking the best possible care for a critical condition. You won’t be limited by medical aid restrictions on specialist fees, allowing you to prioritize the best available expertise for your situation.
Remember: Gap cover isn’t a magic bullet. It has limitations, so choosing a plan with the right level of coverage is essential. However, the peace of mind, financial freedom, and potential for greater choice it offers can make a world of difference during a medical emergency.
Gap Cover Providers: A Look at Cinagi and Turnberry
Now that you understand how gap cover works, let’s explore two prominent providers in South Africa: Cinagi and Turnberry.
Cinagi: The Streamlined Champion
Cinagi is a gap cover provider known for its completely digital platform. This means signing up and activating your policy is a breeze. You can get covered quickly and efficiently, without the hassle of paperwork. Click here to get a quote.
Turnberry: The Established Authority
Established in 2001, Turnberry boasts a long-standing reputation in the gap cover industry. They offer a variety of gap cover products designed to cater to different needs and budgets.
Medical emergencies are unpredictable, but with gap cover, you can be prepared for the financial blow they can deliver. It acts as a powerful shield, protecting you from unexpected medical bills and empowering you to focus on what truly matters – getting better.
Whether you choose a streamlined digital provider like Cinagi or a well-established brand like Turnberry, gap cover offers peace of mind, financial freedom, and potentially greater choice when it comes to your healthcare. Don’t wait until a medical emergency strikes. Take control of your health journey and explore the benefits of gap cover today. Remember, a small investment now can make a world of difference when you need it most.
Clarity Employee Benefits is an authorized Financial Services Provider – FSP No. 51007. We specialize in medical aid and gap cover, please do not hesitate to contact us if you are in need of health insurance guidance or advice.