Group Gap Cover
Group Gap Cover for Your Employees
Group gap cover is an insurance policy your company takes out for its employees to cover the difference between what specialists charge in hospital and what the medical scheme pays. It is regulated as insurance, not as a medical scheme, and usually costs far less than moving staff onto a richer medical aid option. We compare group gap cover providers and help you add it to your benefits in a way that fits your budget.
Why medical aid shortfalls are an HR problem
Medical schemes pay specialists at a set scheme rate. Many specialists charge more than that rate for in-hospital procedures, and the difference, the shortfall, lands on the employee.
For your business, those shortfalls show up as:
- Employees taking unpaid leave or loans to cover hospital bills
- Stress and distraction after a medical event, at exactly the wrong time
- Frustration with the benefits package, even when the medical aid itself is good
- HR fielding difficult claims queries it isn’t equipped to resolve
Group gap cover closes that gap, and employees notice the difference the first time they need it.
What group gap cover typically includes
Benefits differ between providers and policy tiers. We compare them line by line for you.
In-hospital shortfalls
Pays the difference between specialist charges and the scheme rate for covered in-hospital procedures.
Co-payments
Covers co-payments or deductibles the scheme applies to certain procedures or hospitals.
Sub-limits
Helps where a scheme option caps specific benefits, such as certain scans or prostheses.
Additional benefits
Depending on the policy, extras such as cancer-related top-ups or casualty cover.
How companies structure group gap cover
| Model | How it works | Best for |
|---|---|---|
| Employer-paid | The company pays the premium for every eligible employee | Companies using gap cover as a visible retention benefit |
| Shared cost | The company subsidises part of the premium | Balancing budget with broad participation |
| Voluntary group scheme | Employees opt in and pay through payroll at group rates | Offering access to group pricing without adding cost |
| Tiered by staff grade | Different policy levels for different grades | Workforces with very different medical aid options |
Gap cover or a richer medical aid option?
Moving a whole workforce up to a more comprehensive medical aid option is one of the most expensive ways to reduce shortfalls. In many cases, keeping employees on a well-chosen option and adding group gap cover gives better protection for in-hospital events at a fraction of the cost.
We model both approaches against your workforce so you can make the call with real numbers. Gap cover works alongside group medical aid, not instead of it.
Tax treatment
Gap cover is short-term insurance, so it is taxed differently from medical scheme contributions. Where the company pays the premium, it is generally treated as a taxable fringe benefit for the employee, and gap cover premiums don’t qualify for the medical scheme fees tax credit. We’ll take your payroll team through how this works in practice. Your tax advisor should confirm the treatment for your company.
How it works
Review
We look at your current medical aid options and where shortfalls are most likely.
Compare
We compare group gap cover providers, benefits, limits and premiums.
Recommend
You get a clear recommendation and costing for each funding model.
Implement
We handle enrolment and explain the cover to employees.
Support claims
Employees get help submitting gap cover claims after a hospital stay.
Frequently asked questions
Is group gap cover worth it for employers?
For most companies, yes. It is relatively low-cost per employee and protects staff from the in-hospital shortfalls that cause the most financial stress, which makes it one of the most visible benefits you can add.
Do employees need to be on medical aid to have gap cover?
Yes. Gap cover pays shortfalls on claims the medical scheme has already paid, so employees need to be members of a medical scheme.
Can we offer gap cover to only some employees?
Yes. Many companies offer it to specific staff grades, or make it available on a voluntary basis at group rates for everyone else.
Is gap cover regulated in the same way as medical aid?
No. Medical schemes are regulated by the Council for Medical Schemes. Gap cover is an insurance product regulated under insurance legislation, with annual benefit limits set by regulation.
Can employees keep the cover if they leave?
That depends on the provider. Some allow employees to convert to an individual policy when they leave; we’ll confirm this when we compare providers.
Related services
Group Medical Aid
Scheme comparison, negotiation and admin for companies with 50+ employees.
Annual Renewal Review
Check increases, option fit and contribution policy before you accept them.
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