Your Guide to Gap Cover Terms

Your Guide to Gap Cover Terms – Learn to Speak the Lingo

When it comes to policies, there are often a host of terms that leave the general public a little confused. This is also the case where gap cover policies are concerned. Whilst a good personal or company medical aid broker should take the time to carefully explain such definitions to you, this doesn’t always happen. Not to worry, we’ve got you covered. Gap cover assists with shortfalls in hospital, as well as certain out of hospital benefits

Here are a few terms that you might want to take note of with regards to your gap cover:Your Guide to Gap Cover Terms – Learn to Speak the Lingo


Although you might have a medical aid policy, you might need to make a co-payment before having certain procedures done. This is normally the case with hospital visits, where an upfront payment is necessary.

Sub-limit cover

Your medical aid policy might have a specified limit in place for certain procedures, prosthetic devices or scans. This is referred to as a sub-limit. Sub-limit cover will prevent you from having to pay in yourself, something that many people dread dealing with.

Tariff gap:

This term specifically refers to the difference between the cost of a treatment or procedure and what your medical aid is prepared to cover. In short, it is the difference between medical aid rates and private rates. Also known as a shortfall, this tariff gap can often amount to bills if you don’t have a gap policy in place.

Oncology benefit:

There are a few gap policies that offer added benefits for procedures linked to cancer. Some of these policies even provide such benefits without a need for hospital admission. Although gap policies can vary and not all will encompass benefits like these, it pays to go through the terms and conditions of each option. That way, you can make the choice that best addresses your needs. Often, people are too quick to choose a policy based on the monthly premium, rather than what they will be able to get in return. This is something that can amount to greater problems once it comes time to claim.

Additional Benefits

Additional benefits such as accidental casualty, personal accident, medical aid & gap cover premiums and international cover may also be available on certain gap cover products

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