Even with a medical aid plan, many South Africans face unexpected shortfalls when they need hospitalisation, surgery, or specialist treatment. Medical schemes typically cover costs at 100% of medical aid tariff, but specialists and hospitals often charge 200% to 500% of that rate. The difference—the “gap”—can leave you with thousands of rands in out-of-pocket expenses.
That’s where medical gap cover comes in. Gap cover policies are short-term insurance products that pay these shortfalls, giving you financial peace of mind. In this guide, we explore the best gap cover options in South Africa for 2025, compare leading providers, and answer common questions.
What Is Gap Cover?
- Definition: Gap cover is an insurance product that covers the difference between what your medical aid pays and what healthcare providers charge.
- Who needs it: Anyone with medical aid (open or restricted schemes). It cannot be taken out without a medical aid policy.
- Typical coverage: Specialist fees, co-payments, oncology shortfalls, sub-limits on scans, casualty ward visits, and sometimes extended family benefits.
Why Gap Cover Matters in 2025
- High medical costs – Surgeons and anaesthetists regularly charge up to 500% above medical aid rates.
- Co-payments on procedures – Medical aids often require co-payments on scopes, scans, and elective surgeries.
- Oncology shortfalls – Cancer treatment can quickly exceed scheme limits.
- Day-to-day protection – Some gap products now extend to casualty wards and emergency cover.
- Affordability – Premiums range from R200 to R600 per family per month—far cheaper than facing a R50,000 hospital bill.
Best Medical Gap Cover Providers in South Africa (2025)
Below we compare leading gap cover providers based on benefits, pricing, and accessibility.
1. Zestlife Gap Cover
- Premiums (2025): From ~R290 per family per month
- Key Benefits:
- Covers up to 500% of medical aid rates for specialists.
- Co-payment cover for hospital procedures.
- Oncology shortfalls covered up to R250,000 per year.
- Sub-limit cover for MRI/CT scans.
- Casualty ward benefit for accidents.
- Why it’s great: Zestlife consistently ranks among the best-value gap cover options with comprehensive benefits at competitive rates.
2. Stratum Benefits
- Premiums (2025): From ~R350 per family per month
- Key Benefits:
- In-hospital specialist shortfalls up to 500% of scheme tariff.
- Co-payment cover for scopes, scans, and certain surgeries.
- Oncology co-payment protection.
- Trauma counselling and extended family support.
- Why it’s great: Stratum is known for flexible plans (Core, Elite, and CoPay plans) allowing families to tailor cover to their needs.
3. Sirago Gap Cover
- Premiums (2025): From ~R310 per family per month
- Key Benefits:
- Specialist shortfalls up to 500% of scheme rate.
- Innovative “Primary Gap” plan for budget-conscious members.
- Sub-limit cover for internal prosthetics.
- Enhanced oncology benefits.
- Why it’s great: Sirago offers entry-level and comprehensive options, making it suitable for both low-income earners and high earners with complex needs.
4. Complimed Gap Cover
- Premiums (2025): From ~R270 per family per month
- Key Benefits:
- 500% cover for specialist fees.
- Covers co-payments and oncology treatment gaps.
- Access to emergency casualty benefit.
- High annual benefit limit (over R200,000).
- Why it’s great: Complimed is one of the most affordable providers, making it attractive to families on a tighter budget.
5. Momentum Gap Cover
- Premiums (2025): From ~R400 per family per month
- Key Benefits:
- Covers 500% of medical aid tariff.
- Oncology, prosthetics, and internal device shortfalls covered.
- Maternity-related benefits.
- Premium waiver benefit if main member dies or becomes disabled.
- Why it’s great: Momentum’s gap cover integrates well with Momentum Health medical aid, but can also be taken as a standalone product alongside other schemes.
6. Discovery Gap Cover (Supplementary)
- Premiums (2025): From ~R460 per family per month
- Key Benefits:
- Specialist shortfall cover up to 500%.
- Oncology and co-payment protection.
- Extended cover for members of Discovery Health.
- Why it’s great: While Discovery’s premiums are higher, integration with its medical aid makes it convenient for existing Discovery members.
7. Liberty Gap Cover
- Premiums (2025): From ~R390 per family per month
- Key Benefits:
- Covers shortfalls up to 500%.
- Comprehensive oncology benefits.
- Sub-limit cover for specialised scans.
- Gap and CoPay plan options.
- Why it’s great: Liberty is known for strong oncology protection, making it ideal for families with higher medical risk profiles.
Comparison Table: Gap Cover in South Africa 2025
| Provider | Monthly Premium (from) | Specialist Cover | Co-Payments | Oncology Benefit | Extra Benefits |
|---|---|---|---|---|---|
| Zestlife | R290 | 500% | Yes | R250,000 | Casualty ward |
| Stratum | R350 | 500% | Yes | Yes | Trauma cover |
| Sirago | R310 | 500% | Yes | Yes | Prosthetics |
| Complimed | R270 | 500% | Yes | Yes | Casualty cover |
| Momentum | R400 | 500% | Yes | Yes | Premium waiver |
| Discovery | R460 | 500% | Yes | Yes | Discovery integration |
| Liberty | R390 | 500% | Yes | Yes | Sub-limit scans |
How Much Does Gap Cover Cost in 2025?
- Range: R270 – R600 per month (per family)
- Cheapest: Complimed (from R270)
- Most expensive: Discovery (from R460+, depending on plan)
- Average: Around R350 – R400 per family per month
Compared to potential out-of-pocket costs (surgeons charging R50,000+ per procedure), this is exceptionally affordable risk cover.
Who Should Get Gap Cover?
- Families with children – kids often need specialist care and hospitalisation.
- Middle-to-high earners – especially those seeing private specialists.
- Cancer patients – oncology shortfalls are massive.
- Maternity patients – delivery costs often exceed medical aid tariffs.
- Anyone on medical aid – even comprehensive plans have gaps.
Tips for Choosing the Best Gap Cover
- Check your medical aid plan – Identify where your shortfalls are likely.
- Compare premiums vs benefits – Cheapest isn’t always best.
- Look at oncology benefits – Essential if you or your family are at higher risk.
- Check waiting periods – Typically 3 months general, 12 months for pre-existing conditions.
- Read exclusions – Some procedures or lifestyle-related treatments may not be covered.
FAQs
1. Can I get gap cover without medical aid?
No. Gap cover only works in conjunction with a registered medical aid plan.
2. Is gap cover worth it in South Africa?
Yes. It costs around R300–R400/month per family, but can save you tens of thousands in hospital bills.
3. Does gap cover include day-to-day doctor visits?
No. It covers in-hospital shortfalls, co-payments, and certain specialist procedures.
4. How soon can I claim after joining?
Most policies have a 3-month waiting period and 12 months for pre-existing conditions.
5. Which is the best overall gap cover in 2025?
For affordability: Complimed.
For comprehensive protection: Zestlife or Stratum.
For Discovery Health members: Discovery Gap Cover.
Conclusion
In 2025, medical gap cover is no longer optional—it’s essential. Even with the best medical aid, the risk of shortfalls is real, especially for hospital specialists and oncology treatments.
- Best value overall: Zestlife – comprehensive and affordable.
- Most flexible options: Stratum – tailor plans to your needs.
- Best budget choice: Complimed – affordable for families under pressure.
- Best for Discovery Health members: Discovery Gap Cover.
By spending a few hundred rand per month, you can protect your family from devastating medical debt and ensure access to quality healthcare.
