Gap cover – is it necessary?

May 7, 2018

In South Africa medical service providers are not regulated. This means that they are able to charge above the medical aid rate of your specific scheme, unless they have a payment arrangement with your scheme and have signed a contract to charge according to the scheme’s rates.


This may result in a member having to pay a provider over and above what the scheme has paid them for hospitalisation.


While some may have savings, not many people are able to afford upfront payments, which schemes refer to as co-payments before a procedure is done.