Skip links

Medical Gap Cover: Do you really need it?

We all want to take care of ourselves and our families. However, medical expenses can be astronomical, leaving you with mountains of debt, or worse, without treatment. Investing in a medical aid plan is a way to safeguard yourself from incurring hefty hospital bills. That’s why many of us fork out thousands each month to ensure we are covered if the unthinkable happens. But do medical aid schemes cover the whole cost? Sadly, no. But don’t worry. Medical gap cover like Elixi Gap is there to pick up the shortfall.


What is medical gap cover?

Nowadays, in any conversation regarding medical aid, the question of whether you have medical gap cover always comes up. While the thought of yet another expense is the last thing you want to agree to, gap coverage can save you in the long run. How? We’re glad you asked. Medical aid schemes set a medical aid rate. This rate is the base amount that medical professionals can charge for procedures. You may be asking yourself why this matters. Your medical aid pays a minimum of 100% of the medical aid rate. Well, unfortunately, medical professionals can (and do) charge up to 500% over this base rate, leaving you to cover the difference.

Luckily, this is where gap cover comes in. Gap cover is a medical insurance product designed to protect you from the shortfall between what your medical aid pays for and what the medical professional charges. Medical gap cover works in conjunction with your medical scheme to help minimise additional expenses for in-hospital procedures and specified outpatient treatments. It won’t, however, cover any items excluded from your medical aid, such as cosmetic surgery.

Reduce the shortfall

The truth of the matter is, no matter your medical aid scheme, you are bound to experience a shortfall somewhere. To make an informed decision, you should be aware of the costs you can incur during in-hospital treatment. Read on below to discover a few of the shortfalls covered by Elixi Medical Gap Cover.


Tariff gap

The difference between the cost of your in-hospital treatment and the amount covered by your medical scheme is a tariff gap. If your medical aid covers 200% of the procedure, but your surgeon charges 400%, there will be 200% outstanding still to pay. Medical gap covers up to 500% of medical aid rates.


Certain medical services are not covered 100% by medical aid schemes. In this case, the member is required to pay a portion of the procedure cost themselves. Depending on the specialist or procedure, these costs can be quite high. Selected medical gap products provide cover for these co-payments. Always read the fine print before choosing your medical aid to make sure you’re aware of the coverage.

Sub-limit cover

Within your chosen medical aid scheme, the amount covered for specific treatments or events may be limited. If you reach the limit for a procedure, you will have to pay in the extra yourself. Gap products offering a sub-limit cover pays for the in-hospital expenses which exceed your sub-limits.

Oncology benefit

While most medical aid schemes have plans including a cancer benefit, it may not cover all your costs. Medical gap cover including oncology is there to assist with shortfalls regarding cancer treatments and biological drugs.

Do you need medical gap cover?

An accident or a medical emergency can happen to anyone. Opting for gap coverage is one of the ways you can limit your expenses if you ever find yourself needing in-hospital treatment. However, only medical scheme members have the option of taking out gap cover. So you will need to take out both. If you want peace of mind when it comes to hospital expenses, then medical gap cover is for you.

Here at Elixi Health, we offer a variety of Elixi Gap Cover plans. Compare our plans today and request a callback. One of our consultants can talk you through all the benefits and find a plan that suits your needs.