GAP Cover

Gap Cover [What is Gap Cover?]

•When people are hospitalized they usually expect all their medical aid bills to be paid in full however this is more than often not the case. Medical aid benefits are limited to the Medical Scheme Tariff (MST) and doctors and specialists can charge in excess of this tariff.
GAP is an in-hospital benefit that complements medical aid by covering all shortfalls that may incur between the tariffs that medical practitioners charge and what your medical aid actually pays.
•Without GAP COVER you are liable for all in-hospital doctor and specialist shortfalls which are not covered by your medical aid. See below E.g.

Claim Procedure Cost Medical Aid Tariff Gap Shortfall Paid
Anaesthetist 4971.05 2395.50 2575.55
Paediatrician 2667.60 1222.80 1444.80
Gynaecologist 17600 3375.60 14224.40
Total: 25238.65 6993.90 18244.75
Gap covers co-payments in-hospital [MRI, CT scans etc.] as well.

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