The short version
- A hospital plan is a medical scheme option. It pays for hospital admissions and the Prescribed Minimum Benefits.
- Gap cover is short-term insurance. You can only buy it if you're on a medical scheme.
- Specialists and anaesthetists often charge more than the scheme rate. Your plan pays its rate; gap cover pays some or all of the rest.
- Gap cover payouts are capped per person each year by regulation, and each policy adds its own limits.
- The less your option pays specialists, the more gap cover matters.
Side by side
| Hospital plan | Gap cover | |
|---|---|---|
| What it is | A medical scheme option, regulated by the Council for Medical Schemes | A short-term insurance policy, regulated as insurance |
| Can you buy it on its own? | Yes | No — you must be on a medical scheme |
| What it pays | Hospital accounts, in-hospital specialists up to the scheme rate, PMBs, Chronic Disease List medicine | The difference between what the specialist charged and what your scheme paid, up to the policy's cover level and annual limit |
| Procedure co-payments | You pay them | Many policies cover them, up to a limit |
| Day-to-day cover | Little or none | None |
Gap cover in 2026, from our data
40
products
15
providers
R53–R705
premium range a month
R395
median premium
Published cover levels: 100%, 200%, 300%, 400%, 450%, 500%, 600%, 700%
Compare every gap cover productHospital plans in 2026, from our data
Cheapest hospital-only plan
Fedhealth flexiFEDSavvy HospitalR1 155 a month for in-hospital cover plus PMBs.
Cheapest plan with any-private-hospital access
Fedhealth flexiFED 1Elect HospitalR2 051 a month with no hospital network restriction.
Computed from published 2026 contributions and brochure figures. Not financial advice.
A worked example
You're admitted for a knee operation. The surgeon charges R30,000 and your scheme's rate for the procedure is R12,000. Your hospital plan pays R12,000, leaving R18,000. A gap policy that pays up to 500% of the scheme rate covers the whole shortfall, because the surgeon charged 250% of the rate. A policy capped at 200% pays up to R24,000 in total, so you'd still owe R6,000.
Illustrative numbers, not a quote.
When a hospital plan alone can be enough
- Your option pays specialists at a high multiple of the scheme rate, or your doctors have payment arrangements with your scheme.
- You have savings set aside to absorb a shortfall.
- You're rarely admitted — but one admission can cost more than years of gap premiums.
When you need both
- You'll see specialists who charge above the scheme rate, common in orthopaedics, anaesthesia and obstetrics.
- Your option has fixed co-payments for procedures such as scopes or joint replacements.
- You're planning a pregnancy or a known procedure. Check gap cover waiting periods first.
Waiting periods on both
Your medical scheme can apply its own waiting periods when you join. Most gap cover policies also have waiting periods for specific conditions, such as pregnancy or joint replacements, and some add a general one. Check both before a planned procedure.
Questions people ask
Can I get gap cover without medical aid?
No. Gap cover only pays shortfalls after your medical scheme has paid, so insurers require proof of membership.
Is gap cover worth it on a hospital plan?
Usually. Hospital plans pay specialists at the scheme rate or a set multiple of it, and specialist fees above that are the most common large bill after an admission. Current premiums are on our gap cover page.
Does gap cover pay for GP visits or medicine?
No. It pays shortfalls on in-hospital treatment and some listed out-of-hospital procedures. Day-to-day costs aren't covered.
Is there a limit on what gap cover pays?
Yes. Regulation caps the total per insured person per year, and each policy sets its own cover percentage and sub-limits. The current cap is on our gap cover page.
Related on Medical Aid Online
Sources
This guide is general information, not financial or medical advice. Medical Aid Online is not a medical scheme. Scheme rules and benefits change every year, so check the scheme's own rules and brochure before you decide.
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