Comparison table

GAP COVER
COMPARISON

With our Gap Cover Comparison Tool,
we eliminate the headache of
selecting the perfect Gap Cover
solution for your needs.

BENEFITS

GAP LIBERAL

Gap Cover

GAP CORE

Gap Cover

GAP ASSIST

Gap Cover

PLUS

Gap Cover

ULTIMATE

Gap Cover

Costs

Age/Premium Age/Premium
Age/Premium
Age/Premium Age/Premium
Age/Premium Age/Premium
Age/Premium Age/Premium
Individual
Family
0 – 29 30 – 39 40 – 49 50 – 59 60+
R172 R202 R229 R320 R365
0 – 64 R360
0 – 64 R415
0 – 64 R401 65+ R659
0 – 64 R461 65+ R731
0 – 64 R466 65+ R752
0 – 64 R563 65+ R880
0 – 64 R583 65+ R873
0 – 64 R704 65+ R1032

R213 000 Overall Annual Limited Per Beneficiary Per Annum (from 1 April 2025)

In-hospital Benefits
Gap Cover
Robotic Surgery
Co-payments & co-payments charged as a percentage
Penalty Fee Co-payments
Day Hospital/Clinic and/or
In-Room Surgical
Procedures Cover
PMB Cover
Hospital Account Shortfalls
Sub-limit Enhancer
Step-down (includes accident, strokes and Cancer Treatment)
Up to 400% max 500%, BMI included
Subject to OAL, R15 000 pp
Subject to OAL
R12 000 pc, max 2 claims pp
Subject to OAL
Subject to OAL.
R4 500 pp. R950 pc, including
a Sub-limit of R1 000 for PVT ward upgrades
R30 000 pppa
This benefit caters for all sub-limts
–
Up to 350%, max 450%
R18 000 pp
Subject to OAL
R11 500 pc, max 1 claim pp
Subject to OAL
Subject to OAL.
R4 500 pp. R950 pc, including
a Sub-limit of R1 000 for PVT ward upgrades
R26 000 pppa, max- R13 000 pc
–
Up to 500%, max 600%
R12 000 pc, Subject to 1 claim pppa
Subject to OAL, R13 500 pc, Including
Co-payment charged as a percentage
Max R8 000 pc, Max 1 claim pp
Subject to OAL
Subject to OAL.
R3 000 pp, R500 pc, including
a Sub-limit of R1 000 for PVT ward upgrades
–
–
Up to 500%, max 600%
Subject to OAL, R17 000 pp
Subject to OAL
R13 000 pc, max 1 claim pp
Subject to OAL
Subject to OAL.
R4 500 pp, R1 000 pc including a

sub-limit of R1 100 for PVT ward upgrades
R36 000 pppa. max R12 000 pc
This benefit caters for all sub-limits
–
Additional 500%. BMI included
Subject to OAL, R37 500 pp
Subject to OAL
R16 000 p/c, 2 claims pp
Subject to OAL
Subject to OAL.
Max R7 800 pp. R1 500 pc, including
a Sub-limit of R2 000 for PVT ward upgrades
Subject to OAL. Max. R40 000 pc
This option caters for all Sub-limits
R15 000 pbpa on-going treatment
after an accident, stroke or cancer treatment

Out-of-hospital Benefits
Primary Care
Specialist Consultation Fee
Casualty Benefit –
After Hours (18:00 pm – 07:00 am)
and all Saturday, Sundays,
and
all Public Holidays
Preventative Care Cover
Appliance Benefit
Trauma Counselling
Accidental Dental
–
R4 500 sub-limit pp, R1 200 pc
Sub-limit of R10 000 pp
Accident & trauma
Child Casualty Illness – 12yrs & younger
R2 000 pc
–
–
R8 000 pp covered within the first
6 months after a traumatic event.
–
–
–

R2 000 Accident & Trauma
–
–
–
–
–
–
Sub-limit of R8 000 pp
Accident & trauma
Child Casualty Illness – 12yrs & younger
R2 000 pc
–
R4 000 pp, R1 300 pc
R4 000 pp covered within the first
6 months after a traumatic event.
–
–
R5 000 sub-limit pp, R1 000 pc
Sub-limit of R15 000 pp
Accident & Trauma
Illness – 13yrs & older R1 500 pc
Child Casualty Ilnness – 12yrs & younger
R3 000 pc
R5 000 Sub-limit pp – R950 pc
R5 500 pp
R6 000 pp covered within the
first 6 months after a traumatic event.
–
R5 500, R850 pc
R7 000 Sub-limit pp, R1 500 pc
Sub-limit of R20 000 pp
Accident & Trauma
Illness – 13yrs & older R2 500 pc
Child Casualty Ilnness – 12yrs & younger
R4 000 pc
R8 500 Sub-limit pp, R1 350 pc
R8 250 pp
R10 000 pp covered within the first
6 months after a traumatic event.
R10 000 pp. R2 500 per fractured tooth

Cancer Benefits
Cancer Co-payment Benefit
Cancer Benefit – Boost
Cancer Benefit –
Breast
Reconstruction
Breast
Reconstruction-
Artificial Prosthesis
Subject to OAL
Subject to OAL
–
–
Subject to OAL
–
–
–
Subject to OAL, R22 000 pc
Subject to OAL
–
–
Subject to OAL
Subject to OAL
Up to 500%, for affected breast
R25 000 for all activities related to the
reconstruction of the non-affected breast
–
Subject to OAL
Subject to OAL
Up to 500%, for affected breast
R40 000 for all activities related to the
reconstruction of the non-affected breast
R4 000 Sub-limit

The following benefits do not form part of the aggregated OAL.

Value-added Benefits
Gap Cover Premium Waiver
Medical Scheme
Premium Waiver
Accidental Death
Cancer Cover
(Initial Diagnosis)
Sira’Go Baby
MedCare cover
6-month period – Accidental death
or total permanent disability
R3 500 pm for 6-months – Accidental
death or total permanent disability
–
Lump sum of R10 000
(Stage 2 onwards)
R2 000 Sub-limit per newborn
For all claims exceeding R9 000
–
–
–
–
R1 500 Sub-limit per newborn
PMB claims exceeding R9 000
6-month period – Accidental death
or total permanent disability
–
–
–
R2 000 Sub-limit per newborn
For all claims exceeding R9 000
6-month period – Accidental death
or total permanent disability
R4 000 pm for 6-months – Accidental
death or total permanent disability
All Adult dependants registered on the policy – R9 000
Child dependants registered on the policy – R3 000
Lump sum of R20 000
(Stage 2 onwards)
R2 000 sub-limit per newborn
For all claims exceeding R9 000
6-month period – Accidental death
or total permanent disability
R5 800 pm for 6-months – Accidental
death or total permanent disability
All Adult dependants registered on the policy – R15 000
Child dependants registered on the policy – R6 000
Lump sum of R33 000
(Stage 2 onwards)
R2 500 Sub-limit per newborn
For all claims exceeding R9 000

* p/c – Per claim | p/b – Per beneficiary | p/m – Per month. All benefit categories are per policy. Refer to Policy Wording for full details and explanations. This document is for basic information purposes only. Premiums are reviewed and may be adjusted annually.