Gap Cover:
Everything you need to know in 2025

Table of Contents:

Welcome to our 2025 Gap Cover guide.

Gap Covers are insurance products that can add great value to your medical aid plan, and can both lower your monthly costs as well as increase overall benefits. You can buy them from various providers.

As with most financial products, choosing the right Gap Cover can be complicated. We’ve written this guide to give you a general overview of how Gap Covers work, and to help you ask your broker the right questions.

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What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover. 

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