What is GapCover?

GapCover is a positive add-on to a medical scheme. The GapCover product provides cover for all amounts charged in excess of the National Health Reference Price List (NHRPL) rates for services rendered while in hospital, provided that such excess does not exceed 4 times the NHRPL rate. GapCover is a product underwritten by Centriq (Santam), administered by Total Risk Administrators (Pty) Ltd and marketed by Optivest Health Services.

Who can apply for GapCover?

GapCover is available to individuals currently on a medical scheme and 65 years of age or younger.  To apply today click here to download the GapCover Application Form.

What does GapCover cost?

Option 1: R95 per month (maximum benefit per year R1 000 000 - 4 x NHRPL)
Option 2: R84 per month (maximum benefit per year R150 000 - 4 x NHRPL)
(For individuals who qualify, irrespective of family size.)

Why GapCover?

In most cases, members have a shortfall between what the medical scheme pays and the actual cost, because the Service Providers are entitled to charge more than the National Health Reference Price List (NHRPL) rates. The shortfall then becomes the member's responsibility and he/she will therefore need to have additional cover in these circumstances.

Some Hospital and Comprehensive Medical Plans offer cover at 100%, 150% or 200% of NHRPL rates for hospitalisation only, while the actual costs could be more than 400% of NHRPL.

GapCover will cover the difference between what your medical scheme will pay and the actual cost of in-hospital doctor's bills up to a maximum of 400% of NHRPL.

To see all GapCover's Benefits please click here to download the GapCover Benefits Form.

Please Note

Confirm benefits covered, exclusions and the rules of the specific medical scheme, as GapCover cannot cover shortfalls within overall annual hospital limits or certain procedures, as stated by the medical scheme rules.

Should your scheme have an annual hospitalisation limit, GapCover will not be liable to pay the difference between what your scheme covers and the cost of the account.

Example:
If the medical scheme specifies that it will cover R10 000 for a prostheses, the member undergoes a knee operation and the prostheses costs R25 000, GapCover will not be liable to pay the difference.

For more information about GapCover, please contact Optivest Health Services on telephone 021- 975-2266.