Gap Cover is an insurance policy that covers the gap between what your medical aid pays and what service providers charge for in-hospital procedures. Healthcare in South Africa is expensive, and most medical aids only cover part of the healthcare providers’ actual rate.
Gap Cover offers you that extra protection, covering the shortfall from your medical aid. You must be a part of a medical scheme to qualify for this health insurance product.
Please note that Gap Cover is not a medical aid, and it is not a substitute for medical aid.
TRA does not impose a general waiting period on its policies; however, condition-specific waiting periods may apply.
STANDARD BENEFITS
Gap Cover
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment
Tariff Shortfall for Targeted Pain Relief
Tariff Shortfall Benefit for Hospitalised Psychiatric Care
Shortfalls on Specialist Consultations
Casualty Cover and Casualty follow-up consultations
Oncology Gap
Accidental Death Cover
Policy Extender
TRA Assist powered by MobiMed
Travel benefit
From R99/m
STANDARD BENEFITS
Gap Cover
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment
Tariff Shortfall for Targeted Pain Relief
Tariff Shortfall Benefit for Hospitalised Psychiatric Care
Shortfalls on Specialist Consultations
Casualty Cover and Casualty follow-up consultations
Oncology Gap
Accidental Death Cover
Policy Extender
TRA Assist powered by MobiMed
Travel benefit
From R99/m
ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover (including for Oncology)
Sub-Limit Cover (internal prostheses)
Medical Aid Contribution Waiver
From R394/m
ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover (including for Oncology)
Sub-Limit Cover (internal prostheses)
Medical Aid Contribution Waiver
From R394/m
ALL VITAL COVER BENEFITS PLUS
Out of Network Co-Payment Cover (including for Oncology)
Co-Payment: Out of Hospital MRI/CT/PET Scans
Sub-Limit Cover for MRI/CT/PET scans and Colonoscopies and Gastroscopies
Global Fee Benefit
Oncology Extender Benefit
Oncology “New-Tech” Benefit
Oncology Gap Benefit for Breast Reconstruction Surgery
Maternity Follow-Up Consultations
Private Ward Benefit
Step-Down facility Benefit
Premature Birth Benefit
From R417/m
ALL VITAL COVER BENEFITS PLUS
Out of Network Co-Payment Cover (including for Oncology)
Co-Payment: Out of Hospital MRI/CT/PET Scans
Sub-Limit Cover for MRI/CT/PET scans and Colonoscopies and Gastroscopies
Global Fee Benefit
Oncology Extender Benefit
Oncology “New-Tech” Benefit
Oncology Gap Benefit for Breast Reconstruction Surgery
Maternity Follow-Up Consultations
Private Ward Benefit
Step-Down facility Benefit
Premature Birth Benefit
From R417/m
ALL SUPER COVER PLUS BENEFITS PLUS
Emergency Medical Services (ambulance)
From R681/m
ALL SUPER COVER PLUS BENEFITS PLUS
Emergency Medical Services (ambulance)
From R681/m
Cover up
to 700%
Fast Claim
Payouts
Easy Claims
Process
Excellent
Service
Out-of-hospital
Benefits
Affordable Prices
From R99 p/m
Automatic Claim
Submission
How TRA Gap Cover Works
with Your Medical Aid:
Here’s what you’re covered for with TRA:
Gap Cover is designed to complement your existing medical aid, not replace it. It steps in when your medical aid doesn’t cover the full cost of hospital treatments, specialist fees, or specific procedures. Rather than leaving you paying out of pocket, TRA fills the “gap”.
Always review your policy documents for specific details.
TRA Makes Gap Cover
Worth It!
*TRA Gap Cover does not apply a general waiting period to its policies. This means you get cover from day one. Most policyholders can enjoy immediate benefits, with only a limited number of procedures and conditions subject to waiting periods or exclusions (T’s & C’s apply).
Always review your policy documents for specific details.
R219 845 in aggregate per insured person per annum* (p/a)
Gap Cover Percentage*
300%
700%
700%
700%
Applies to authorised in-hospital and in-lieu of hospital procedures, where the medical aid pays a portion of the fees from its in-hospital or major medical benefit. (Includes MRI/ CT/PET scans consumables.)
R525* per
policy p/a*
R1 050* per
policy p/a*
R3 150*
per policy p/a*
R5 250*
per policy p/a*
Pain Relief Benefit – Provides cover for targeted pain relief treatment during surgery or following a severe trauma. This is covered even if the medical aid pays from day-to- day benefits or savings, provided the treatment forms part of an authorised in-hospital procedure, funded from the medical aid’s Risk or Major Medical Benefit.
Unlimited* but subject to the aggregate annual limit per insured person per annum
Unlimited* but subject to the aggregate annual limit per insured person per annum
Unlimited* but subject to the aggregate annual limit per insured person per annum
Unlimited* but subject to the aggregate annual limit per insured person per annum
Tariff Shortfall cover for service provider costs related to in-hospital mental health admissions requiring psychiatric care.
21 days*
21 days*
21 days*
21 days*
A once-off lump sum from day 11 onwards for extended stays in a registered step-down or sub-acute care facility following hospitalisation.
R8 000*
per insured person
per annum
R12 000*
per insured person
per annum
Covered, subject to medical
aid review
Cover for the shortfall on a specialist account related to the consultation in the rooms before a member is going for an in-hospital procedure.
Limited to the following number of consults p.p.p.a (up to a max of R500 per consult)
2 consults per policy p/a*
3 consults per policy p/a*
4 consults per policy p/a*
The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services.
DSP’s (Voluntary use of
designated service provider
networks)
Up to R14 335* per
policy p/a
Up to R66 150* per
policy p/a
NON DSP’s (Voluntary use of
non-designated service
provider networks)
1 co-payment
per policy
per annum.
Up to R5 513*
2 Co-payments /
deductibles per
policy per annum
to a combined
maximum of
R17 640*
1 MRI / CT / PET
scan per policy p/a
up to R13 230*
2 scans per policy
p/a. Unlimited but
subject to the
aggregate annual
limit per insured
person p/a*
Sub-Limits*: Internal Prostheses
Up to R12 128* per
policy p/a
The shortfall on a service provider account that is not covered because you have reached the sub-limit for MRI / CT / PET scans imposed by your medical aid AND which has been
authorised and paid from the In-Hospital or Major Medical benefit.
1
MRI, CT or PET
scan up to
R3 969* per scan
2
MRI, CT or PET
scans up
to R6 615*
per scan
The shortfall on a service provider account that is not covered because you have reached the sub-limit for Colonoscopies and Gastroscopies imposed by your medical aid AND
which has been authorised and paid from the In-Hospital or Major Medical benefit.
Up to R14 333* per
policy per annum
Up to R3 780* per
event
Up to R24 225* per
insured person per annum
Up to R6 300* per
event
Unlimited but subject to
the aggregate annual limit
per insured person p/a
(Casualty/ER Unit linked to a hospital)
Up to R3 640* per
policy p/a
Up to R9 700* per
policy p/a
Up to R14 335* per
policy p/a
Up to R24 225* per
policy p/a
(The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.)
1 follow-up consultation
per policy p/a
at an ER unit
(accident-related only)
1 follow-up consultation
per policy p/a
at an ER unit
(accident-related only)
1 follow-up consultation
per policy p/a
at an ER unit
(accident-related only)
1 follow-up consultation
per policy p/a
at an ER unit
(accident-related only)
Global Fee Benefit*
Up to R13 230* per
policy p/a
Up to R26 460* per
policy p/a
(Subject to medical aid
approved treatment plan
being covered up to scheme
tariff and within annual
scheme oncology limit)
Oncology Co-Payment Benefit (In Network)*
Up to R14 333* per
policy p/a
Up to R66 150* per
policy p/a
1 co-payment per
policy per annum.
Up to R5 513*
2 Co-payments per
policy per annum
up to a combined
limit of R17 640*
(Includes ANY costs above
annual scheme oncology
limit but subject to scheme
covering up to this limit)
Up to R38 588* per
policy p/a*
Oncology “New-Tech” Benefit*
Up to R9 040* per
policy p/a*
Up to R18 191* per
policy p/a
The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology
related breast reconstruction surgery, including the unaffected breast. (NB: Subject to the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within the annual scheme oncology limit).
Up to R19 845*
per beneficiary per life
of the policy
Up to R38 588*
per beneficiary per life
of the policy
A fixed payout is provided in the event of a baby being born before 34 completed weeks of gestation. (Excludes elective deliveries).
R15 000*
per policy
per annum
R20 000*
per policy
per annum
Provides cover towards a policyholder’s medical aid
contribution in the case of the accidental death of the main policyholder.
Cover is limited to the
lower of the actual medical aid contribution or the maximum
amount allowed.
6 months.
Up to a max of R4 850* per month.
6 months.
Up to a max of R6 060* per month.
6 months.
Up to a max of R7 275* per month.
Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth
Up to R735* per
policy p/a
Up to R1 313* per
policy p/a
The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred.
For Childbirth: Limited to a maximum of R550* per day, for a total of 3 consecutive days
For Non-Childbirth: Limited to a maximum of R550* per day, for a total of 3 consecutive days
For Childbirth: Limited to a maximum of R2 205* per day, for a total of 3 consecutive days
For Non-Childbirth: Limited to a maximum of R2 205* per day, for a total of 3 consecutive days
Insured / Spouse
Dependant
R7 700
R4 400
R11 000
R6 060
R22 000
R8 800
R33 000
R22 000
(Additional 12 month gap
cover premiums covered
upon accidental death of
policyholder)
Emergency Medical and Related expenses up to R1 000 000
Home Drive (including Uber)
Panic Button (includes a Roadguard service)
Medical Health Line & Trauma Counselling Line
(includes a COVID-19 CARE LINE)
Claims Submissions.
Under 65’s (Based on the age of the oldest Beneficiary)
premium per policy per month.
Premium per Individual per policy per month
Premium per Family per policy per month
Over 65’s (Based on the age of the oldest Beneficiary)
premium per policy per month.
R99
R197
R394
R394
R591
R417
R626
R681
R846
The policy is subject to terms, conditions, and a list of excluded procedures. Certain conditions and procedures may still have a specific waiting period.
*SUBJECT TO AN AGGREGATE ANNUAL LIMIT OF R219 845 PER INSURED PERSON
This limit may be subject to regulatory amendment. Sub-Limits may apply. Refer to the Policy Document for full details of limitations and exclusions.
Terms and Conditions apply. This product comparison does not constitute advice. Consult your intermediary for guidance in choosing the product that is right for your needs. Prescribed Minimum Benefits (PMB’s) are covered. Errors and Omissions Excepted. A full list of 2026 terms and conditions can be viewed here.
With TRA, signing up for is a breeze. In just 5 minutes, you can secure comprehensive coverage that fills the gaps in your medical aid shortfalls.
Not sure if you need it?
Just tell us about yourself and your medical aid, and we’ll let you know if it’s important for you. With our simple tool and expert help, you’ll quickly find the perfect policy for your needs.
WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES
AND WHAT YOUR MEDICAL AID PAYS.
WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES AND WHAT YOUR MEDICAL AID PAYS.
Gap Cover eliminates financial stress in case of hospitalisation by protecting you from medical shortfalls. Never assume that your medical aid will cover 100% of your in-hospital expenses.
Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.
Gap Cover eliminates financial stress in case of hospitalisation by protecting you from medical shortfalls. Never assume that your medical aid will cover 100% of your in-hospital expenses.
Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.
At TRA, we use the Net Promoter Score (NPS) to understand how likely you are to recommend us. We simply ask: “Would you recommend TRA to a friend or colleague?” Your answer helps us gauge your satisfaction and identify areas for improvement.
Gap Cover is an affordable health insurance policy that gives you and your family peace of mind when you need it most.
This health insurance product is becoming a necessity in South Africa as doctors and medical aids continue to increase their rates exponentially each year.
Gap Cover is not a medical aid plan but has helped hundreds of South Africans avoid financial debt. Get Gap Cover for your Medical Aid with Total Risk Administrators (TRA). Visit our Hellopeter page to find out how our policyholders feel about our service and products as one of the best Gap Cover providers in South Africa.
Gap cover insurance is essential for covering shortfalls after medical treatments like surgeries or hospital stays where the specialist’s fees are higher than what your medical aid covers. Once your medical aid has processed and paid their portion of the bill, you can claim the remaining amount from your gap cover provider, according to the terms of your policy.
Absolute Cover Plus is TRA's premium gap cover offering that works hand in hand with your registered medical aid scheme.
Copyright: Consumer research conducted by BrandMapp on behalf of Total Risk Administrators (TRA), 2025. “With only 19% of medically insured
Understanding medical aid tariffs and what "above-tariff" means is crucial for every medical aid member in South Africa. Medical aid
