Quick Facts

• Covers specialist fees that medical aids don’t pay in full
• Plans start from R157 per month in 2025
• Only available to Discovery Health Medical Scheme members
• Automatic 3-month waiting period for most procedures
• Coverage up to R210,580 per person per year

What Is Gap Cover?

Gap cover is insurance that pays for medical bills your medical aid does not cover. Your medical aid has limits on what they pay doctors and hospitals. When your doctor charges more than this limit, you must pay the difference yourself.

Discovery Gap Cover is designed specifically for Discovery Health Medical Scheme members. It helps you avoid large medical bills you were not expecting.

Why You Need Gap Cover

Most specialists in South Africa charge between 200% and 500% above medical aid rates. This means if your medical aid pays R10,000, your specialist might charge R30,000 or more. You would need to pay R20,000 from your own pocket.

Without gap cover, a single hospital visit can cost you tens of thousands of Rand. Gap cover protects you from these unexpected costs.

Important to Know

Gap cover is NOT a medical aid. You must have a medical aid first. Gap cover works together with your medical aid to cover the shortfalls.

Discovery Gap Cover is regulated by the Financial Sector Conduct Authority (FSCA). It is underwritten by Discovery Insure Ltd, a licensed and authorised insurance company.

Discovery Gap Cover Options

Discovery offers three different gap cover plans. Each plan has different benefits and costs. You choose the one that fits your needs and budget.

1. Discovery Gap Active (Entry-Level Option)

This is the basic option. It covers shortfalls on specialist fees when you are in hospital. It does not have extra benefits like cancer cover or international travel cover.

2. Discovery Gap Core (Standard Option)

This plan includes everything in Gap Active plus extra benefits. It covers more types of medical expenses.

3. Discovery Gap Comprehensive (Premium Option)

This is the most complete plan. It includes all benefits from Gap Core plus additional coverage for scans, scopes, and international travel emergencies.

💰 Costs and Premiums (December 2025)

The cost of Discovery Gap Cover depends on several factors. Your premium is based on your age, family size, and which Discovery Health Medical Scheme plan you are on.

Starting Prices for 2025

Plan Option	Starting Price
Discovery Gap Active	From R157 per month
Discovery Gap Core	From R200 per month
Discovery Gap Comprehensive	From R250-R500 per month
Supplementary Illness Benefit (Add-on)	From R85-R100 per month

What Affects Your Premium

Age: The premium is based on the age of the oldest person on your medical aid plan.

Medical aid plan: Different Discovery Health plans have different premiums. Executive plans cost more than Coastal plans.

Family size: More people on your plan means higher premiums.

Vitality status: Your Vitality level can give you extra benefits but does not reduce the premium.

Real Cost Example

A single person aged 35 on the Discovery Classic Comprehensive plan would pay approximately R200-R300 per month for Gap Core. A family of four might pay R500-R700 per month depending on ages and plan type.

These are estimates only. Contact Discovery directly for accurate quotes based on your personal details.

✅ What’s Covered: Benefits Breakdown

In-Hospital Specialist Gap Cover

This is the main benefit on all three plans. When your specialist charges more than what your medical aid pays, gap cover pays the difference.

Coverage: Up to 500% of the medical aid rate. This means if the medical aid pays R10,000, gap cover can pay up to R50,000 more.

Applies to: Surgeons, anaesthetists, physicians, radiologists, pathologists, and dental specialists (when covered by your medical aid’s hospital benefit).

Hospital Admission Benefit Extender

This benefit covers gaps that remain after your medical aid and specialist gap cover have paid. It depends on your Vitality status.

Vitality Status	Annual Benefit
Blue or No Vitality	Up to R5,000 per year
Bronze	Up to R7,500 per year
Silver	Up to R10,000 per year
Gold	Up to R12,500 per year
Diamond	Up to R15,000 per year

Oncology (Cancer) Benefit Extender

If you are registered on your medical aid’s cancer benefit and reach the oncology threshold, this benefit helps with co-payments.

Gap Core: Up to R110,000 per person per year

Gap Comprehensive: Up to R100,000 per person per year

Scopes and Scans Benefit Extender (Comprehensive Only)

Only available on the Discovery Gap Comprehensive plan. It covers co-payments and deductibles for:

• MRI scans done outside hospital
• CT scans done outside hospital
• Endoscopies (gastroscopy, colonoscopy, sigmoidoscopy, proctoscopy) done in hospital

Travel Benefit Extender (Comprehensive Only)

Covers shortfalls on approved emergency medical claims when you travel outside South Africa. Includes the $150/€100 deductible for out-of-hospital emergency claims.

Covers shortfalls once you reach your medical aid’s travel limit of R5 million per person per trip.

Private Ward Cover

If you choose a private ward instead of a general ward, gap cover pays the difference. Subject to hospital availability and your medical aid’s approval.

Limit: Up to 5 days per year on most plans.

Third Trimester Maternity Cover

Covers shortfalls on maternity claims in the third trimester of pregnancy. Only applies if your medical aid plan does not have a Medical Savings Account.

Requirements and Eligibility

Who Can Apply?

You must be a member of Discovery Health Medical Scheme. This is the most important requirement. Discovery Gap Cover is not available to members of other medical aids.

KeyCare plans are excluded. If you are on a KeyCare plan, you cannot apply for Discovery Gap Cover.

All members must be covered. Everyone on your medical aid plan must also be on your gap cover policy. You cannot select only some family members.

Waiting Periods

3-month general waiting period: You cannot claim for any procedures during the first three months, except for authorised emergency hospital admissions.

12-month pre-existing condition waiting period: Any medical condition diagnosed or treated in the 12 months before you apply will not be covered for 12 months.

Exception: Emergency hospital admissions are covered from day one.

What Documents You Need

• Your Discovery Health Medical Scheme membership number
• ID numbers for all people to be covered
• Proof of your current medical aid plan
• Banking details for debit order payments

What Happens If You Change Plans?

If you downgrade your Discovery Health plan (for example, from Executive to Essential), your gap cover might need to change too. Contact Discovery to update your gap cover.

If the oldest person on your plan leaves or joins, your premium will change. You must inform Discovery within 31 days.

✅ How to Apply for Discovery Gap Cover

Step 1: Check Your Eligibility

Make sure you are on a qualifying Discovery Health Medical Scheme plan. KeyCare plans do not qualify.

Step 2: Choose Your Plan

Decide which gap cover option suits your needs:

• Gap Active: Basic in-hospital specialist cover only
• Gap Core: Includes cancer benefits and hospital admission extender
• Gap Comprehensive: Full coverage including scans, scopes, and travel

Step 3: Get a Quote

Contact Discovery to get an accurate quote for your specific situation:

Step 4: Complete the Application Form

You can apply online, through your financial adviser, or by downloading the application form from Discovery’s website.

You will need to provide details for all family members to be covered.

Step 5: Set Up Payment

Provide your banking details for monthly debit order payments. Premiums are collected on the first day of each month.

Step 6: Wait for Approval

Discovery will review your application. This usually takes 2-5 working days. You will receive a policy schedule showing your cover details.

Step 7: Understand Your Waiting Periods

Remember the 3-month waiting period for non-emergency procedures. Emergency admissions are covered immediately.

How Claims Work

The good news: you don’t need to submit gap cover claims yourself. Discovery identifies gaps automatically when your medical aid processes claims.

Your gap cover claim is paid directly to the healthcare provider. You don’t receive the money yourself.

Alternative Gap Cover Providers in South Africa

While Discovery Gap Cover is only for Discovery Health members, many other gap cover providers work with all medical aids. Here are the top alternatives for 2025:

1. TRA (Total Risk Administrators)

HelloPeter Trust Index: 9.7/10 (Ranked #1 in South Africa)

Starting from: R99 per month

Works with: All registered medical aids

Highlights: Fast claims processing (within 10 business days), excellent customer service, comprehensive coverage options

2. iWyze

HelloPeter Trust Index: 10.0/10 (Perfect score)

Starting from: R150-R200 per month

Works with: All registered medical aids

3. Stratum Benefits

HelloPeter Trust Index: 7.2/10

Starting from: R197 per month (Access Optimiser plan)

Works with: All registered medical aids

Highlights: Over 10 years experience, multiple plan options from basic to elite

4. Turnberry

HelloPeter Trust Index: 2.5/10

Starting from: R169 per month

Works with: All registered open medical schemes and most closed schemes

Plans: Premier, Optimal, Synergy, Launch – with coverage up to 600%

5. Zestlife

HelloPeter Trust Index: 7.9/10

Focus: Affordable, budget-friendly gap cover

Works with: All registered medical aids

Provider	Starting Price	Trust Rating
TRA	R99/month	9.7/10
iWyze	R150/month	10.0/10
Discovery	R157/month	N/A
Turnberry	R169/month	2.5/10
Stratum	R197/month	7.2/10

🚨 Scam Warnings & Consumer Protection

Medical Insurance Fraud Is Rising in South Africa

Medical scheme fraud costs South Africa between R8 billion and R43 billion per year. This fraud affects everyone through higher premiums.

Common Gap Cover Scams

1. Healthcare Provider Billing Fraud

The Scam: Some specialists ask patients if they have gap cover before deciding what to charge. If you have gap cover, they charge much more.

Why It’s Wrong: Providers are exploiting gap cover to inflate bills. The same procedure costs different amounts based on your insurance.

How to Protect Yourself: You are NOT obliged to disclose whether you have gap cover. Never tell healthcare providers about your gap insurance before treatment.

2. Double Claiming Fraud

The Scam: People pay for medical treatment out of pocket, then claim from gap cover. Both the medical aid and gap cover pay out.

Why It’s Wrong: This is illegal. It’s called “unjustifiable enrichment.” You can be prosecuted.

Consequences: Policy cancellation, criminal charges, and you must repay all fraudulent claims.

3. Multiple Gap Cover Policies

The Scam: People take out gap cover with two or more providers and claim from both for the same medical event.

Why It’s Wrong: This is fraud. Insurance companies share information and will detect this.

4. Fake Gap Cover Providers

The Scam: Criminals impersonate legitimate insurance companies and sell fake gap cover policies.

Red Flags:

• Too-good-to-be-true premiums (much cheaper than competitors)
• No FSP (Financial Services Provider) number
• Pressure to pay immediately
• Payment to personal bank accounts (not company accounts)
• No physical office address

How to Verify a Legitimate Gap Cover Provider

Discovery’s FSP Details

Discovery Insure Ltd: FSP Number 1596

Registration Number: 2009/011882/06

Licensed Insurer: Yes – regulated by FSCA and Prudential Authority

What NOT Covered by Gap Cover

Understanding exclusions prevents disappointment and potential disputes:

• Cosmetic surgery: Unless due to trauma or cancer treatment
• Obesity treatment: Including bariatric surgery (stomach stapling)
• Experimental treatments: Not approved by medical aid
• Rejected claims: If medical aid rejects the claim, gap cover won’t pay
• Claims older than 6 months: Must submit within 6 months
• Out-of-pocket deductibles: Unless specifically covered by benefit extenders
• Overseas treatment: Except emergency travel claims on Comprehensive plan

Where to Report Fraud

⚠️ Important Limitations and Exclusions

Gap Cover Will NOT Pay For:

Medical aid rejections: If your medical aid does not approve a claim, gap cover cannot pay. Gap cover only pays shortfalls on approved claims.

Non-designated service providers (DSP): If you use a non-network hospital or provider without authorization, gap cover might not pay the full amount.

Claims during waiting periods: The 3-month general waiting period and 12-month pre-existing condition waiting period must be respected.

Foreign currency claims: Claims charged in foreign currency (except approved international travel claims on Comprehensive).

Annual Limits

Discovery Gap Cover has overall annual limits per person:

• Gap Comprehensive 2025: R210,580 per person per year
• Gap Core 2025: R198,000 per person per year
• Gap Active 2025: Lower limits apply

Once you reach this limit, gap cover stops paying for the rest of the year.

Your Consumer Rights and Protection

You Have the Right To:

• Fair treatment: Discovery must treat all policyholders fairly and equally
• Clear information: All policy terms must be explained in plain language
• Privacy: Your medical information is protected under POPIA (Protection of Personal Information Act)
• Object to terms: You have 31 days to object to any policy terms
• Cancel your policy: You can cancel at any time with written notice
• Complain: You can lodge complaints with Discovery or escalate to regulators

How to Complain About Gap Cover

Step 1: Contact Discovery first

Call: 0860 99 88 77 or email: service@discovery.co.za

Give Discovery 30 days to resolve your complaint.

Step 2: Escalate to FAIS Ombud

If Discovery does not resolve your complaint, contact:

Step 3: Report to FSCA

For serious misconduct or regulatory violations:

Keep These Documents Safe

• Your gap cover policy schedule
• All premium payment receipts
• Medical aid statements and claims
• Hospital and specialist invoices
• All correspondence with Discovery

You may need these documents if you have a dispute or complaint.

Gap Cover vs Medical Aid: Understanding the Difference

Feature	Medical Aid	Gap Cover
What it is	Primary health insurance	Secondary/supplementary insurance
Regulated by	Council for Medical Schemes	FSCA (short-term insurance)
Can work alone	Yes	No – must have medical aid
Typical cost	R2,000-R8,000+ per month	R150-R500 per month
What it covers	Medical expenses up to scheme rates	Only the shortfalls/gaps
Mandatory?	Required for gap cover	Optional

Who Should Get Discovery Gap Cover?

You should consider Discovery Gap Cover if:

• You are a Discovery Health Medical Scheme member (not on KeyCare)
• You are concerned about unexpected medical bills
• You want automatic claims processing
• You value the integration with Discovery Health
• You can afford R200-R500 per month for protection

Which Plan Should You Choose?

Choose Gap Active if: You only need basic specialist cover and want the lowest premium.

Choose Gap Core if: You want comprehensive in-hospital cover including cancer benefits. Best value for most people.

Choose Gap Comprehensive if: You want maximum coverage including scans, scopes, and international travel. Recommended if you travel often or have family history of cancer.

If You’re Not on Discovery Health

Consider TRA (starting R99/month) or iWyze (perfect 10.0 trust score). Both work with all medical aids and have excellent customer reviews.

Essential Safety Tips

• Never tell healthcare providers you have gap cover before treatment
• Always verify FSP numbers before buying any insurance
• Keep all policy documents and payment receipts safe
• Understand your waiting periods before having procedures
• Compare at least 3 providers before choosing
• Read the full policy document, not just the brochure

Final Thoughts

Gap cover is an important financial safety net. Medical bills can be devastating without it. A single hospital procedure can cost you R50,000 or more out of pocket.

If you can afford R200-R300 per month, gap cover is worth the investment. It protects your family from financial hardship when medical emergencies happen.