Total Risk Administrators
Gap Cover
Medical aid is not the safety net most members think it is. Even on a comprehensive plan, healthcare providers often charge more than what your medical aid pays for a procedure, and the difference then sits with the member to cover, not the scheme. That difference is known as a shortfall, and it’s what gap […]
Gap cover is a short-term insurance product designed to cover the financial shortfall between what your medical aid pays and the actual costs charged by private healthcare providers. In South Africa, medical aid schemes often reimburse healthcare services at a predetermined rate, known as the medical scheme tariff (MST). However, specialists and hospitals may charge […]
Most people picture one thing when they hear “medical aid”: a comprehensive plan with all the bells and whistles you hardly use. However, what people don’t often realise is that an entry-level hospital plan can still be a type of medical aid, registered and regulated under the same Medical Schemes Act just as any comprehensive […]
Are you aware of the annual aggregate limit for your medical aid or gap cover provider and how it can affect you and your family? Terms used in insurance can often be complicated and overwhelming. However, medical aid members need to understand what these terms mean and how they affect their medical scheme and short-term […]
Some things just work better when they’re together; medical aid and gap cover are no exception. With medical treatment and specialist costs as high as they are, regardless of your medical aid scheme, there is often a shortfall in covering the full costs charged by healthcare providers. Without the perfect gap cover policy to pair […]
Taking out medical gap cover can prove life-saving, especially when you are admitted to a hospital and risk incurring shortfall costs. Medical aid scheme rules and regulations can be exasperating and frustrating to follow. Why do our medical aid benefits run out when we need them the most? And why do medical aids cover some […]
Dis-chem Gap Cover and TRA Gap Cover are two of South Africa’s main gap insurance providers, but their plans differ on cover ceilings and on the number of plans each offers. Dischem covers up to 600% above scheme tariff across two plans (Base and Summit). TRA covers up to 700% across four plans, starting at […]
Gap cover for Discovery medical aid pays the in-hospital shortfalls your medical aid does not. When a specialist charges 300% of the Discovery Health Rate but your plan only pays 200%, you cover the difference out of pocket. TRA gap cover could settle that gap for authorised in-hospital procedures, up to 700% of scheme tariff. […]
If you have shopped around for gap cover in South Africa, you have probably seen plans advertised at 200%, 500% or 700%. The numbers look arbitrary, and most brochures do not bother to explain them. They matter, though. The percentage on your gap cover policy is what decides whether your bill from the anaesthetist/other specialists, […]
If you are a medical aid member in South Africa, consider TRA’s Basic Cover 300, designed to provide affordable, entry-level gap cover for protection against medical aid shortfalls. What Is TRA’s Basic Cover 300? Basic Cover 300 is TRA’s entry-level gap cover policy, available from R99 per month for an individual and R197 per month […]
Balancing the demands of life can often feel overwhelming. We find ourselves juggling many aspects of daily life, and at times, our health can fall victim to this aftermath. While physical health has long enjoyed the spotlight, mental health is gaining the recognition it deserves as an integral component of overall wellness. Total Risk Administrators […]
Both cover hospital costs, but in different ways. Medical aid pays benefits up to your plan’s limits. Gap cover pays the shortfall when doctors charge above those limits. Simple enough, but the detail matters. Here’s what you need to know about using both for complete healthcare protection What is Medical Aid? When it comes to […]
Many South Africans are unaware of what medical gap cover is or why it’s essential. A common misconception is that medical aid covers 100% of in-hospital procedures, but this isn’t true. Medical aids only pay up to a set tariff rate, leaving you responsible for any shortfall when doctors charge above this amount. These gaps […]
Medical aid schemes often leave a gap (known as medical shortfalls) between what the medical aid pays and the actual cost of the treatments. This gap can arise from in-hospital procedures, which are capped at a medical aid tariff (the amount the medical aid covers) or co-payments imposed by your medical aid. Gap cover is […]
If you ask several people if they know what gap cover is, many might have a general idea, but often, there is a misconception surrounding how it works. One common misconception is that you’re 100% covered for all in-hospital costs if you are a member of a registered medical aid. Unfortunately, this is not the […]
In general, we all aim to ensure that our health, and that of our loved ones, is looked after. However, the past few years have shown that there are no guarantees regarding healthcare costs or medical cover. For many South African families, unexpected medical expenses can quickly become a financial burden without the right safety […]
Dental treatment can be costly. Even with comprehensive medical aid plans, often you’ll find that not all expenses associated with dental treatments are covered. This is where gap cover becomes essential, bridging the gap between what your medical aid pays and the actual costs of the procedures, in this case, what your dental practitioners charge. […]
It’s a scenario playing out across South Africa every day: You’re diligent with your medical aid payments. You go in for a necessary procedure. Everything gets approved. Then comes the gut punch: a bill for R20,000 that your medical aid won’t cover. That begs the question: How is this possible with comprehensive medical aid? Well, […]
Medical aids and medical schemes in South Africa don’t cover the full cost of healthcare. The gap between what medical aid pays and what healthcare providers charge creates significant financial risk for employees. Corporate gap cover bridges this gap, protecting your workforce from unexpected medical costs and debt. What Is Corporate Gap Cover? Corporate gap […]
Copyright: Consumer research conducted by BrandMapp on behalf of Total Risk Administrators (TRA), 2025. “With only 19% of medically insured South Africans currently having gap cover, there are literally millions of families who could benefit from this protection but haven’t yet recognised the need.” When you’re lying in a hospital bed recovering from surgery, the […]
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Gap cover pays the difference between what your medical aid covers and what specialists charge. TRA answers the question “What is Gap Cover?”
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