Gap cover is a handy add-on to your medical aid that provides financial assistance when you have run out of your Medical Scheme Savings or if you have reached your day-to-day benefit sub-limit. Oneplan Gap Cover includes Out- and In-Patient benefits such as in-hospital shortfalls, co-payments, and other deductibles at an affordable monthly premium.
While medical aids cover a significant portion of expenses, they often have limits on procedures and specialist fees. Gap health cover acts as a supplementary layer, filling the GAP between what your medical aid covers and the actual costs of treatment, especially when specialists charge above medical aid rates. This additional cover helps protect you against unexpected medical bills so you can get the best health care possible without worrying about significant out-of-pocket expenses.
No sub-limits. We double or quadruple the scheme payout. No fuss, no complications.
Cover from a trusted brand that delivers what we promise.
We pay shortfalls and co-payments, even when you are within your MSA Savings Threshold.
Cover for mental health conditions when not related to a self-inflicted injury
Added Cancer cover. All cancers are covered, no questions asked (subject to like-for-like and pre-existing waiting periods)
Accidental Death Cover and HIV Treatments at no extra premium
To submit a claim to your GAP Cover policy, simply WhatsApp (083 794 5452) or e-mail (gapclaims@oneplan.co.za) the payment statement from your Medical Scheme after the Insured event. You may need to send supporting documentation like proof, medical evidence, or information in writing as reasonably requested by the Insurer. All claims are processed within 7 days from the date of receiving ALL required documents, considering the latest document’s submission date if provided separately.
Yes. GAP Cover helps you to claim in the event of when you have exhausted your medical aid savings or encounter situations where your medical aid cover is insufficient, which means you can only get a GAP Cover policy if you have proof of an existing medical aid policy. If you are interested in getting medical cover that’s more affordable than medical aid, you can head over to Oneplan Health Insurance to see our range of comprehensive, affordable healthcare plans here.
You have the option to either get cover for yourself only, or for a family, or only certain members of your family. You have the option to cover a family up to four on the Oneplan Core or Executive GAP Cover Plans.
Medical Aids are regulated by the Medical Schemes Act, whereas gap cover is short-term insurance product which, together with your medical aid, provides top-up health cover up to certain limits. The purpose of cover is to provide additional financial protection to medical scheme members who receive in-hospital treatment and care so that they are not saddled with large out-of-pocket expenses following a hospital event.
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