Most medical scheme members will experience co-payments, deductibles and tariff shortfalls in and out of hospital.

Gap and shortfall insurance, are optional top-ups regulated or exempted by the Council for Medical Schemes, to assist you fill some or all of these gaps:

• Tariff differences in-hospital, where contracted out surgeons and anaesthetists charge 3 – 7 x more than the medical aid rates many medical scheme options pay
• Shortfalls on prostheses and other sub-limits
• Co-pays on MRI and CT scans, gastroscopies and endoscopies
• Cancer limit and co-pay top ups
• Specialised & biological drugs
• Out of DSP hospital network benefit
• Excluded procedures such as elective joint and spine surgery.

Prices vary from basic tariff Gap cover to comprehensive shortfall cover. Waiting periods of up to one year are regulated, if you are new to Gap cover, but often cover a baby born into cover.

Preferential terms, and custom benefits, are negotiable for compulsory or large groups.