The right medical scheme keeps your family healthy without draining your salary, and gap cover catches the specialist bills your medical aid simply won’t pay. We help you choose both, from the whole market rather than one brand.
Scheme & gap cover options we advise on
Medical aid options range from basic hospital plans to full comprehensive cover. Paying for a top-tier plan you never use is as costly as being underinsured when you land in hospital. We match the plan to your real needs.
Cover major, unexpected in-hospital events: surgery, accidents, serious illness. Lower premiums, ideal if you’re young and healthy and can budget for day-to-day visits.
Adds day-to-day benefits (GP visits, dentistry, optometry, chronic medication), usually through a savings account and above-threshold benefit.
We compare Discovery Health, Momentum Health and other registered schemes side by side: benefits, networks, chronic cover and the small print that matters.
Here’s the trap: medical schemes pay specialists at a fixed “scheme rate”, but many specialists (surgeons, anaesthetists, radiologists) charge up to 5× that rate. The difference lands on you, often as a shock invoice after surgery.
Gap cover is an affordable extra policy that pays that shortfall. For a small monthly premium it can save you tens of thousands of Rand on a single hospital stay.
Read: the specialist bill your medical aid won’t pay →
| Situation | What gap cover does |
|---|---|
| In-hospital shortfalls | Pays the gap between the scheme rate and what your specialist actually charges (up to your policy’s limit) |
| Sub-limit top-ups | Boosts cover for scopes, scans and internal prostheses where your scheme caps the benefit |
| Co-payments | Refunds the fixed co-payments your scheme charges for certain procedures |
| Cancer & oncology | Extends cover once your scheme’s oncology benefit is exhausted |
“After my knee op the specialist and anaesthetist bills came to nearly R28,000 more than the scheme paid. Our gap cover settled every cent. Best R300 a month we’ve ever spent.”
From day-to-day GP visits to major hospital events and the shortfalls in between, these are the healthcare products we advise on and place.
We’ll review your current medical aid and check whether gap cover makes sense for your family, in plain language, with no jargon.
