Unlock the Best Medical Aid in South Africa for Your Family

Yes, many specialists charge more than medical aid rates. Gap Cover can help pay these shortfalls, reducing your out-of-pocket expenses.

Gap Cover may cover specialist shortfalls in hospital, co-payments for certain procedures, cancer treatment shortfalls, casualty and emergency room fees, and some diagnostic procedures. Benefits vary between providers.

Generally, members can only change plan options during the medical scheme's annual option change period, usually towards the end of the year for the following year.

Chronic medication may not be paid if the condition is not registered, the medication has not been authorised, the prescription has expired, or the medicine is not on the scheme's formulary.

In most cases, yes, you can add your parent as a dependant on your medical aid, provided your medical scheme's rules allow it and your parent is financially dependent on you. Common requirements include: your parent being financially dependent on you, either fully or partially; proof of dependency (for example, an affidavit, proof of financial support, or bank statements); a copy of your parent's ID; and any additional supporting documents the scheme may ask for.

A pre-existing condition is any illness, injury, disease, or medical condition for which a person has received medical advice, diagnosis, treatment, medication, or symptoms before joining a medical aid or upgrading to a new option. A 12-month condition-specific waiting period may apply.

Your membership will be suspended or terminated if contributions remain unpaid.

Some medical aid options use designated service providers (DSPs) and provider networks to keep costs lower. Using non-network providers may result in co-payments.

Most medical schemes require that a newborn baby be registered as a dependant within a specified period after birth, usually within 30 days. If registered within this period, cover is generally effective from the baby's date of birth, subject to the scheme's rules. Contact your broker or medical aid immediately after the birth and submit the required documents to ensure your baby's membership is activated without delay, so that medical expenses for the newborn are covered from birth.

A waiting period is a period during which certain benefits are not available. This may include a general waiting period of up to 3 months or a condition-specific waiting period of up to 12 months.