Gap Cover

In certain cases the cost for in-hospital procedures or outpatient treatment may exceed the base medical aid rate by six times. By taking out Sanlam Medical Gap Cover Insurance, you ensure that you and your family aren’t left with a large excess amount to settle.

• You need to be an existing member of a registered medical aid scheme.
• Gap cover extends to the principal member, their spouse and children until they reach the age of 27. Families covered on two medical aids will be covered by a single Sanlam Gap Cover policy.
• Special dependants may be included (excluding financially dependent parents).

Yes, the following waiting periods apply:

• A general waiting period of 3 months on all benefits.
• A 12 months condition specific for pre-existing conditions for which you received advice, treatment or diagnosis during the 12 months prior to the cover commencing.
• Please refer to our Policy Document for 2025 (Section H) for more information.

• Treatment for obesity, including bariatric surgery (stomach stapling).
• Treatment for cosmetic surgery unless necessitated by a trauma or as a result of oncology treatment (e.g. breast reconstruction following a mastectomy).
• Specialised Dentistry is only paid for on the Sanlam Gap Cover Comprehensive Plan in the event of trauma, cancers and tumours.
• Claims older than 6 months.
• Any claim that is excluded or rejected by the Insured’s medical scheme.
• Please refer to our Policy Document for 2025 (Section I) for more information.

Comprehensive Medical Gap Cover

• Under 30
  Single R320pm
  Families R485pm
• 30 – 45
  Single R444pm
  Families R540pm
• 45 – 60
  Single R495pm
  Families R582pm
• Over 60
  Single R832pm
  Families R999pm

When submitting the Claim form, you will need to provide supporting documents as detailed below in the checklist. Claims can be emailed to gapclaims@centriq.co.za. Once received, your Claim will be processed and if all requirements have been met, the Benefit amount will be paid within 7 to 10 working days. Please direct all queries to the Sanlam Gap Service Centre on 0861 111 167.

Download claim form

We require the following documents from you to process your claim:

• Claims transaction remittance (receipt) from the medical scheme.
• Relevant doctors’ accounts.
• Hospital account (the first four pages showing admission/discharge times and ICD codes).
• Current medical scheme membership certificate (copy of the membership card is not accepted).

An e-mail and SMS is sent to the member when:

• The claim is captured.
• Outstanding documentation is requested (assuming you have not signed the authority form).
• The claim is authorised.

Please note that payments will be made directly into the principal member’s bank account.

1. Can my family (principal member, spouse and child/children) be on more than one medical aid scheme under one Sanlam Gap policy?

Yes

2. Will my parents that are dependants on my medical scheme have cover under my Sanlam Gap Cover policy ?

Financially dependent parents will be required to take out their own gap policy as Sanlam Gap will only cover the principal member, partner/spouse and children (under the age of 27).

3. Are supplementary benefits paid from the statutory limit of R210 580?

No, the supplementary benefits are additional benefits Sanlam offers their clients.

4. How long do I have to submit my gap cover claim?

Six months from the insured event.

5. Family Protector Benefit: Who is eligible to claim for this benefit?

All the beneficiaries covered on the policy can claim for this benefit in the event of death or permanent disability due to accidental harm. Children below six years R20,000, all other insured parties R30,000.

6. If a member was on a lower gap offering (for longer than 12 months) and joined Sanlam Gap Comprehensive, would Sanlam Gap impose waiting periods on their new enhanced/richer benefits?

No

7. Does Sanlam Gap have a list of conditions that are excluded for the first 12 months of cover?

No, only pre-existing conditions will be excluded for 12 months if the client did not have previous cover.

8. Will Sanlam Gap cover planned PMB (Prescribed Minimum Benefits)?

Yes, within the rules of your policy document.

9. How long do I have to register my newborn baby?

You have 90 days of which to add your baby onto your policy.

10. The penalty co-payment for the use on a non-network hospital is subject to a maximum of one event per family per annum and a maximum of?

A maximum of two such events are covered under this benefit per annum and up to a maximum amount of R18,550 per event, subject to the Key Benefit Limit.