Best described as insurance for insurance. Now if that sounds like the end of the world to you then you might be onto something…
Every single Medical Aid option, no matter what premium, has co-payments and/or potential shortfalls applying for almost anything. This form of insurance, ensures that there aren’t ‘Gaps’. Key word here is ‘Gaps’ because this isn’t ‘Hole’ cover. For example, Discovery Health doesn’t have any external prosthesis sub-limit cover whatsoever lower than Priority series. Therefore if a Classic Saver member needs a moon boot or back brace post hospital admission, there is zero cover, not even a R1 sub-limit. Gap cover isn’t allowed to fill in that ‘hole. If there were some coverage, even R1 applying from Hospital benefit then Gap cover could ’sweeten’ up the benefit but only then.
The most common claim for Gap cover is for overcharging specialists in-hospital. It’s great peace of mind to know that you can use any specialist you like no matter what rates they charge (the best ones normally do charge more). Otherwise, co-payments (excess in car insurance terms) are very common claims and we are getting more and more successful casualty claims paid out. And yes, casualty is in fact ‘Hole’ cover, so there are exceptions. Here are our two Gap insurers explained in detail:
Pro’s – By a long long way (in our opinion), SA’s # 1 Gap cover provider. We are talking about 1 week claims turn-around times, qualified/knowledgeable claims & support staff. The free travel insurance benefit is just an extra boost with Gap cover & Medical Aid for that matter. It’s really down to paying claims consistently and efficiently, that’s what Turnberry does. 
Con’s – Dependents aged 25 and 11 months are free, but from age 26 they start paying additional adult rates. Also there is no discount for a single member on the Gap cover policy as with Stratum.
1 – TURNBERRY EXPLAINED (2022)
2 – EXCLUSIONS ALL OPTIONS (2022)
3 – PREMIER OPTION GUIDE (2022)
4 – OPTIMAL OPTION GUIDE (2022)
5 – SYNERGY OPTION GUIDE (2022)
Pro’s – Discounts for single members and no higher rates charged for additional dependents aged 26 or more. Discovery Keycare option’s perfect companion is found in Stratum’s Access Optimiser option @ just R155 for a family, being unbelievable value for money.
Con’s – Much longer turn-around times for claims than for Turnberry and inconsistency with claims handling. That said, we always evaluate how much of a cost saving it is on Stratum before automatically opting for a higher premium with Turnberry.
1 – STRATUM (NON-KEYCARE) EXPLAINED (2022)
2 – ELITE OPTION BENEFITS (2022)
2 – ELITE OPTION EXCLUSIONS (2022)
3 – COMPACT 300 OPTION BENEFITS (2022)
3 – COMPACT 300 OPTION EXCLUSIONS (2022)
4 – DISCOVERY KEYCARE PLUS OPTION + STRATUM EXPLAINED (2022)
