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Gap cover is designed to protect you from unbudgeted healthcare costs.
Payment shortfalls occur when Medical Schemes:

  • pay for treatments at a lower rate than that charged by your doctor
  • impose co-payments for certain procedures or treatments
  • have limits on the amount they pay for certain treatments (sub-limits)

Our gap cover has been designed to protect you from these costs and to boost your medical aid cover. We also provide you with additional benefits and cover when you need it most.


  • Overall annual limit of R150 000 per insured person per annum (pippa)
  • Cancer co-payment cover limited to 20%, subject to overall limit
  • Sub-limit enhancer limited to R44 000 per event/condition
  • No annual sub-limit for co-payment cover
  • Additional 500% tariff cover
  • Hospital consumables limited to R5000 pfpa


Unless otherwise approved the following will apply:

  • 3 month general waiting period
  • 12 month pre-existing condition exclusion

Cover provided for principal member, spouse and children registered on same medical aid

Cover for dependants only applies to your spouse and/or children up to age 26. Other dependants are not covered.

Standard exclusions apply – refer to policy document
Contact us about underwriting waivers for groups

Service Providers

This product is distributed by Hippo Advisory Services, an authorised financial services provider (FSP No: 36088). All products are underwritten by Auto & General, an authorised financial services provider (FSP No: 16354).

Gap Cover is not a medical scheme and the cover is not the same as that of a medical aid scheme. The policy is not a substitute for medical scheme membership. It boosts the cover provided by your medical scheme.

Monthly Cost  2018

INDIVIDUALS R296             GROUPS (20+) approx Quoted separately

Benefits  2018

Overall Limit R150 000 per insured person per annum (pippa)

Payment Shortfalls (Tariff)
In hospital specialists - additional 500% - no sub-limit
Blood tests - no sub-limit
Consumables - R5 000 pfpa
MRI/CT/PET scans - additional 500% - no sub-limit
Rand based pre-admission co-pays - no sub-limit
All procedure specific co-payments - no sub-limit
Penalty co-payments/deductibles - 1 pfpa (max R12 800)

In-hospital internal prostheses sub-limits increased by R44 000 per event/condition

Hospital Booster Benefit
Paid for trauma and premature birth (more than 6 weeks early) only
Day 1 - 13 R300
Day 14 - 21 R600
Day 22 - 31 R1 200
Maximum benefit of R20 000 pippa
Payment shortfalls (tariff)
5 procedures commonly performed in Dr’s Rooms
MRI/CT scans
Payment Shortfalls (Tariff)
Additional 500% tariff cover
All % co-payments up to 20% subject to overall limit
If % co-payment does not apply -
100% cover exceeding any annual sub-limits
subject to overall limit
Lump Sum Payout
Positive Diagnosis - R10 000 pb
6 month medical scheme and gap premium waiver on death or
permanent disability of member (R4400pm)

Death or permanent disability cover - accidental - R24 000

600% cover for post trauma reconstructive facial surgery,
surgical correction of birth defects and
intracranial neurosurgery

R12 000 payout for premature birth >42 days early

Dental reconstruction due to oncology
or trauma - R40 000 per event/condition

Accidental casualty ward benefit - R12 800 per event

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