GapCover provides a benefit equal to actual cost limited to 4 times the medical scheme rate less payment for treatment received for services rendered by doctors and/or pecialists while hospitalized as an inpatient.
GapCover is a product underwritten by Western National Insurance Company Limited, administered and marketed by Optivest Health Services (PTY) Ltd.
Who can apply for GapCover?
GapCover is available to individuals currently on a medical scheme and 65 years of age or younger. To apply today click here to download the GapCover Application Form.
What does GapCover cost?
Option 1: R99 per month (maximum benefit per year R1 000 000 - 4 x medical scheme rate)
Option 2: R85 per month (maximum benefit per year R150 000 - 4 x medical scheme rate)
(For individuals who qualify, irrespective of family size.)
Why GapCover?
In most cases, members have a shortfall between what the medical scheme pays and the actual cost, because the Service Providers are entitled to charge more than the medical scheme rate. The shortfall then becomes the member's responsibility and he/she will therefore need to have additional cover in these circumstances.
Some Hospital and Comprehensive Medical Plans offer cover at 100%, 150% or 200% of medical scheme rates for hospitalisation only, while the actual costs could be more
than 400% of medical scheme rates.
GapCover will cover the difference between what your medical scheme will pay and the actual cost of in-hospital doctor's bills up to a maximum of 400% of medical scheme rates.
To see all GapCover's Benefits please click here to download the GapCover Benefits Form.
Waiting Period
- Incurred for a period of 3 months from inception date except in the event of emergencies.
- Maternity benefits will only accrue after a 12-month waiting period.
- 12-month general waiting period on pre-existing conditions.
Please Note
Confirm benefits covered, exclusions and the rules of the specific medical scheme, as GapCover cannot cover shortfalls within overall annual hospital limits or co-payment on certain procedures, as stated by the medical scheme rules. Should your scheme have an annual hospitalisation limit, GapCover will not be liable to pay the difference between what your scheme covers and the cost of the account.
Example:
If the medical scheme specifies that it will cover R10 000 for a prostheses, the member undergoes a knee operation and the prostheses costs R25 000, GapCover will not be liable to pay the difference.