Gap Cover: How it saves you money (2025)

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You can often save a lot of money by choosing a medical aid plan with co-payments, sublimits and networks and pairing it with a good gap cover.

In fact, pairing a lower-level medical aid plan with a gap cover often gives you better in-hospital benefits than a high priced medical aid plan on its own.

Let’s look at some examples, where we just choose a network plan over a non-network plan. Assume a family of 2 adults and 2 young children.


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.