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NetcarePlus GapCare
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NetcarePlus GapCare

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cover when your medical aid runs out

Because medical aid alone won't always be enough to get you the quality care you need, or to take care of unexpected expenses and shortfalls. You need gap cover that makes more of your medical aid.

This is not a medical scheme, and the cover is not the same as that of a medical scheme. This insurance product is not a substitute for medical scheme membership.

Why gap cover?

What is gap cover Why do you need it? How does it work?
What is gap cover What is gap cover - mobile

What is gap cover?

Gap cover is basically top-up insurance for your medical aid. It bridges the gap between medical expenses and what your medical scheme covers.

Why do you need gap cover Why do you need gap cover - mobile

Why do you need gap cover?

  • Specialists often charge more than the amount covered by your medical aid
  • The hospitals and specialists you want to use may fall outside of your medical aid network
  • You could reach the limit of your medical aid's benefits
  • Hospitals can also charge co-payments for certain procedures

Without gap cover, you'll have to pay for these expenses out of your own pocket.

How does it work How does it work - mobile

How does it work?

Medical aids set an annual rate that is paid to specialists for every procedure. Based on your medical aid option, you can be covered at different multiples of your medical aid rate.

Specialists usually charge more than what your medical aid covers, causing a shortfall between their rate and the medical aid rate.

This is when gap cover kicks in, protecting you against unexpected expenses and giving you access to the care you need.

What are the benefits?

NetcarePlus GapCare covers you beyond the limits of your medical aid and gives you access to world-class doctors and hospitals.

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In-hospital specialist fees

You'll be covered for specialist shortfalls for any approved admission in a hospital or day clinic. Plus, we'll also take care of consultations while you’re admitted to hospital.

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Up-front co-payments

You'll be protected against upfront co-payments for certain day procedures, like scopes or scans performed in hospital or a day clinic.

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Out-of hospital specialist shortfalls

You'll be covered against specialist shortfalls for consultations and treatment, when you're not admitted to hospital.

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Cover in an emergency department

You'll receive emergency medical treatment for injuries beyond the cover of your medical aid.

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Extended maternity benefits

You'll be protected against maternity costs beyond medical aid limits, even for high-risk pregnancies. Plus, we'll take care of prenatal consultations, private ward costs, and first hearing screening and immunisations.

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Day-to-day medical costs

You'll be covered for specialist consultations if referred by your GP, including cover for radiology, pathology, as well as basic and specialised dentistry, once you’ve reached your day-to-day limits.

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Unlimited admissions in any Netcare facility

You'll get unlimited cover for co-payments when using Netcare hospitals outside of your medical aid network.

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Comprehensive cancer treatment

You'll be covered for co-payments for cancer treatments beyond the limits of your oncology benefits. Plus, shortfalls when using providers outside of your medical aid network.

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Emergency booster

You'll be covered for costs incurred in any emergency department when you require emergency medical treatment, including for consultations and medication.

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If you need any further information, please contact your company broker

How it helped Lindiwe How it helped Lindiwe - mobile

Lindiwe, 35

Wisdom teeth removal

How it helped Lindiwe

01

Lindiwe is a financial clerk at an accounting firm. She has GapCare from NetcarePlus included in her employee benefits, which covers her beyond the limits of her medical aid.

How it helped Lindiwe

02

Lindiwe needs to have her wisdom teeth removed. She is unsure of which specialist to see for the procedure, so she gets a recommendation from her dentist.

How it helped Lindiwe

03

Her dentist refers her to a specialist experienced in wisdom teeth surgeries. The specialist does not practise at a hospital in her medical aid network, but for her own peace of mind, Lindiwe books the procedure with the specialist.

How it helped Lindiwe

04

The total cost of the procedure comes to R19 287, including the hospital, specialist, and anaesthetist fees. Her medical aid only pays R9 285, which results in a shortfall of R10 002.

How it helped Lindiwe

05

Lindiwe is covered for the R10 002 shortfall under GapCare, which she otherwise would've had to pay out of her own pocket.

How it helped Lindiwe

06

The accounting firm provides all its employees with GapCare from NetcarePlus. This way, the firm can make a positive impact on the health and financial well-being of employees whose medical aids don't always cover them in full.

The scenario is for illustrative purposes only. Claims covered by GapCare will depend on medical aid payouts and the benefits available as part of the GapCare policy.

Underwritten by The Hollard Insurance Co. Ltd, a Licensed Non-Life Insurer and Auth.FSP. NetcarePlus is an Auth.FSP.