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A family of four, mother and father holding their two children’s hands as they run in an open field as the sun sets.

Gap cover

Gap cover bridges the gap between your in-hospital medical bills and your medical aid cover.

If you want an obligation-free gap cover quote, speak to your financial adviser or call us today on 0860 102 936.

Use gap cover to pay for medical aid shortfalls.
Choose a plan suitable for you.

from

R236 per month

Get gap cover View brochure (pdf)

What is gap cover?

Momentum GapCover⁺ bridges the gap between your in-hospital medical bills and medical aid cover. You can use your cover to help pay for in- and out-of-hospital fees when your medical aid doesn't cover all the costs.

With Momentum GapCover, you can choose a suitable plan to ensure you’re prepared for any unexpected shortfall.

Gap cover is not a medical aid. This product is not a substitute for medical aid cover.

How much does it cost?

< 30 (Millennial GapCover)

R236 pm

Policy member under 42

R379 pm

Policy member over 42

R533 pm

Policy member over 65

R669 pm

No dependants may be added to gap cover if the principal insured is over the age of 65 at the time of applying for the cover.Rates are per policy per month. No dependants may be added to Momentum GapCover if the principal insured is over 65, or on Millennial GapCover.

Gap cover benefits

Shortfall benefits

These benefits aggregate to a maximum benefit of R190 000 per insured person per year.

Medical practitioner costs

Covers up to 3 times the amount paid by the medical aid if there is a shortfall between what is charged by the medical practitioner and what is paid by the medical aid.

Co-payments

Covers co-payments applied by your medical aid, including the 20% co-payment applied to oncology treatment after reaching the medical aid limit. This benefit does not cover co-payments payable for voluntary use of non-Designated Service Providers.

Casualty

Covers the casualty cost fees associated with admissions to the emergency room, at a registered hospital casualty facility, due to a medical emergency or accident.

Limited to 5 casualty visits and up to R23 000 per policy per calendar year.

Three of these casualty ward visits, up to R4 000, may be used in an emergency for child dependants 7 years or younger.

Internal prosthesis

Covers shortfalls on internal prosthesis costs, up to a maximum amount of R35 000 per policy per year. Cover for stents and pacemakers are now included to a max of R8 000 per claim event.

Assist benefit

These benefits do not aggregate to the R190 000 cap.

Cancer assist benefit

If you are diagnosed with minimum stage 2 local and malignant cancer whilst covered by this policy, we will pay you R8 000.

If, however, you are diagnosed with minimum stage 2, regional and malignant cancer, we will pay you R20 000.

If, after receiving the R20 000 benefit, your medical aid pays more than R200 000 for the cost of your oncology treatment within 12 months of your diagnosis, we will pay you a further R15 000.

Accident assist benefit

The benefit of R55 000 is payable for death or permanent disability due to an accident. Subject to one claim per insured per lifetime.

Trauma and bereavement counselling

If you are a victim of, or witness to, an act of violence (such as murder, assault, robbery, rape, kidnapping or hijacking) or a traumatic accident, we will refund a fixed amount of R800 per session for any trauma counselling you’ve had, limited to R30 000 per family per year.

Additional benefits

Violent crime benefit – R110 000 payable for death or permanent disability due to a violent crime.

Premium waiver benefit - R36 000 payable upon the death or permanent disability of the premium payer.

Baby bump benefit - Benefit of R2 500 payable when existing GapCover members fall pregnant.

Breast reconstruction benefit for non-affected breast - if you are diagnosed with breast cancer and require cosmetic breast reconstruction for the non-affected breast due to a mastectomy, we will provide cover of R15 000 per policy per year.

Want to know more?

For more information relating to the below, please view the brochure and navigate to the relevant section.

Waiting periods.

How to claim.

Out-of-hospital/day clinic procedures.

What we do not cover.

Terms and Conditions of cover.

GapCover brochure (pdf)

⁺You may choose to make use of additional products available from Momentum Metropolitan Holdings Limited (Momentum), to seamlessly enhance your medical aid. Momentum is not a medical scheme and is a separate entity to Momentum Medical Scheme. The complementary products are not medical scheme benefits. You may be a member of Momentum Medical Scheme without taking any of the complementary products.

Get gap cover today

Be prepared for any unexpected shortfalls.

Get gap cover

Need medical aid advice?

An accredited consultant will call you to discuss our gap cover and medical aid options and benefits.

Request a call back

Contact Momentum Medical Scheme

Client service, claims and authorisations

0860 102 936

WhatsApp us

Join an online help session.

+27 31 573 4008

[email protected]
Business hours are Monday to Friday from 08:00 to 17:00. Saturday and public holidays from 08:00 to 16:00. Closed on Sundays.

For local emergencies

082 911

Available 24 hours a day, 7 days a week, 365 days a year.

For international emergencies

+27 11 541 1263

Available 24 hours a day, 7 days a week, 365 days a year.

Momentum Medical Scheme Ethics and Fraud line

0800 000 438

[email protected]

Available 24 hours a day, 7 days a week, 365 days a year.

Other Momentum contacts