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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

Healthcare costs can be unpredictable, and your medical scheme may not always cover the full cost of in-hospital procedures or specific treatments.

Momentum GapCover+ provides essential supplementary cover to fill those gaps, ensuring you're protected against potential shortfalls. Choose between:

  • GapCover Primary for more affordable coverage, or
  • GapCover Supreme for more extensive protection.
From

R259 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?

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.

What level of cover applies per medical aid option?

Ingwe, Custom, and Evolve Options: Up to 400% of the Momentum Medical Scheme Rate.

Incentive and Extender Options: Up to 800% of the Momentum Medical Scheme Rate.

Summit Option: Up to 1 200% of the Momentum Medical Scheme Rate.

Gap cover benefits

Shortfall benefits

These benefits aggregate to a maximum benefit of R200 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

If you visit a casualty ward within 24 hours of an emergency caused by an accident, we will pay up to R24 000 of all costs incurred.

This benefit is limited to 5 casualty visits per family per year. 3 of these visits, limited to R5 000 per policy per year, may be used in an emergency (regardless of whether it was an accident) for a child aged 8 years or younger.

The cost of these 3 visits would count toward the R24 000 annual limit.
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 R200 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.

+ Momentum Medical Scheme members may choose to make use of additional products available from Momentum Group Limited and its subsidiaries as well as Momentum Multiply (herein collectively referred to as Momentum). Momentum is not a medical scheme and is a separate entity to Momentum Medical Scheme. Momentum products are not medical scheme benefits. You may be a member of Momentum Medical Scheme without taking any of the products offered by Momentum.

Why Momentum GapCover+?

Customisable plans Choose the coverage that fits your needs
Financial peace of mind Avoid unexpected healthcare costs
Comprehensive protection Cover for hospital, day clinic, and certain out-of-hospital treatments

Want to know more?

For more information about waiting periods, how to claim, out-of-hospital or day clinic procedures, what we do not cover per option, and terms and conditions of cover, please read the Momentum GapCover+ brochure.

Gap cover brochure (pdf)

Get Momentum GapCover+ today

Don’t let medical shortfalls catch you off guard. Ensure you have the protection you need with Momentum GapCover+. Contact us today to learn more or explore our detailed coverage options.

Get gap cover 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.

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