Medical aid
We help you explore medical aid options through our listed relationships with Discovery, Momentum and Fedhealth. TopMed, referenced on our previous website, forms part of Fedhealth following the schemes’ amalgamation.
Gap cover
Medical scheme benefits and the fees charged by healthcare providers may differ. We help you consider gap cover for eligible shortfalls through Stratum and Sirago. Benefits, limits and exclusions depend on the selected policy.
Who this suits
Medical aid and gap cover advice suits anyone choosing, changing or questioning their healthcare cover:
- Individuals and families joining a medical scheme for the first time
- Employees leaving a group scheme who need their own plan
- Growing families whose needs have changed
- People over 35 joining for the first time, where late-joiner penalties apply
- Members with chronic conditions who need reliable benefits
- Anyone on a hospital plan who wants protection against in-hospital shortfalls
Problems we help with
The situations that most often bring people to us, and that a review is designed to catch.
Paying for a plan you do not use
Comprehensive benefits when a hospital plan would do, or day-to-day savings that run out by June.
Shortfalls on hospital bills
Specialists charging more than the scheme rate, leaving you with an account after a procedure.
Confusion about what is covered
Prescribed minimum benefits, chronic conditions, networks and co-payments are hard to compare between schemes.
Waiting periods when switching
Moving at the wrong time, or with a gap in membership, can bring new waiting periods and exclusions.
Network restrictions
A cheaper plan that requires you to use specific hospitals or doctors, discovered at the wrong moment.
Annual increases with no review
Contributions rise every January while the plan itself is never reconsidered.
What happens during a review
A review is a conversation, not a commitment. Here is how it usually runs.
- 01
We look at your household
Who needs cover, existing conditions, how often you see doctors and specialists, and your budget.
- 02
We check how you use your current plan
Claims history, savings account use and any shortfalls you have paid.
- 03
We compare options
Plans across the schemes we work with, and gap cover products, matched to your needs rather than to a brochure.
- 04
You get a clear recommendation
Plan, contribution, key limits and the trade-offs, so you can decide with the facts in front of you.
- 05
We time the change and stay in touch
Applications, option changes at year end, and a review each year before the new contributions apply.
Review cover around your household
Have your current plan, dependants, budget and preferred hospitals or providers in mind. Discuss health details privately with the adviser rather than through this enquiry form.
Before we speak
Is gap cover a replacement for medical aid?+
No. Gap cover is insurance for specified eligible shortfalls and has its own limits, exclusions and waiting periods.
What should I check before changing plans?+
Compare provider networks, benefits, co-payments and applicable waiting periods. Confirm the new arrangements before ending existing cover.
Plain-English guide
Terms you will see on schedules and quotes, explained without the jargon.
- Medical scheme
- A registered, not-for-profit fund that pays members’ healthcare costs. “Medical aid” is the everyday term for membership.
- Hospital plan
- A medical scheme option that covers in-hospital treatment but little or no day-to-day care. A hospital cash insurance policy is a different product.
- Comprehensive plan
- A plan that adds day-to-day benefits, often through a medical savings account.
- Medical savings account
- A portion of your contribution set aside for day-to-day expenses such as GP visits and medicine.
- Gap cover
- Insurance that pays the difference between what a specialist charges and what your scheme pays, within limits.
- Co-payment
- An amount you pay towards a procedure, scan or medicine, set as a fixed sum or a percentage.
- Scheme rate
- The amount your scheme will pay for a service. Specialists can charge several times this rate.
- Prescribed minimum benefits
- A set of conditions and treatments every scheme must cover in full, regardless of plan, generally when you use its designated providers and treatment protocols.
- Designated service provider
- A hospital, doctor or pharmacy your scheme requires you to use to avoid co-payments.
- Late-joiner penalty
- A loading on contributions that a scheme may apply to people who join at 35 or older without enough previous scheme membership to their credit. It is capped by regulation and does not expire.
- Waiting period
- A period after joining during which certain conditions or benefits are not covered.