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NetcarePlus Gapcare
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From

R275

per month

Gap Cover Gap Cover Gap Cover
Hollard

NetcarePlus Gapcare

Gap cover that goes beyond the limits of your medical aid

Life is unpredictable, we're here to help. NetcarePlus GapCare is an affordable insurance product that protects you against in and out-of-hospital shortfalls in your medical aid cover and gives you access to the widest choice of hospitals and specialists.

Hollard
Affordable Cover
Affordable cover for both in and out-of hospital shortfalls
Cover Costs
Cover for day-to-day costs beyond medical scheme limits
Maternity Benefits
Maternity shortfalls for mom and baby
Access Treatment
Access world-class treatment from specialists and hospitals
Benefits
In-hospital specialist shortfalls

In-hospital specialist shortfalls

We cover the shortfalls for approved medical procedures and consultations while you are admitted in hospital.

Out-of-hospital specialist shortfalls

Out-of-hospital specialist shortfalls

We will cover the shortfalls for out-of-hospital consultations and treatments by a medical specialist.

Emergency medical treatment in an emergency department

Emergency medical treatment in an emergency department

We cover the shortfalls for any medical emergency beyond your scheme limits.

Day-to-day costs beyond medical scheme limits

Day-to-day costs beyond medical scheme limits

We will cover specialist consultations, dentistry, radiology and pathology beyond your medical scheme limits.

Co-payments and deductibles

Co-payments and deductibles

You'll receive cover for upfront payments required by your medical scheme for procedures such as scopes or scans performed in-hospital or in a day clinic.

We also cover

We also cover

  • Shortfalls in cancer treatment
  • Shortfalls in maternity costs
  • Shortfalls in trauma counselling
  • Medical aid contributions on accidental death or disability
  • GapCare premiums on accidental death or disability
  • Out of network hospital co-payments
  • Charges above sub-limits
Download the full brochure


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.

How much will it cost me?

Complete the questions below to get an online quote.

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Gap cover is only available to individuals who have a medical aid or hospital cover, have a look at our Accident and Trauma Cover which may be more suitable to your needs.

Accident and Trauma Cover

From R225 per month

Our product covers your emergency medical costs for accident and trauma events at our network of private hospitals across the country.

Accident and Trauma Cards Accident and Trauma Cards

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

Your quote

The prices shown are based on the information provided by you.

Below is more information on the range of gap cover products available from NetcarePlus.

GapCare quote options

In-hospital specialist shortfalls
Co-payments and deductables
Cancer treatment
Out of network hospital co-payments
Charges above sub-limits
Emergency medical treatment in an Emergency Department
Maternity costs
Out of hospital specialist shortfalls
Day-to-day costs beyond medical scheme limits
Trauma counselling
Premium waiver
In-hospital specialist shortfalls

Additional 500% of the medical scheme tariff

Co-payments and deductables

The medical scheme may require an upfront payment for certain scopes and scans performed in-hospital or in a day clinic.

This benefit covers the co-payment or deductible that has been applied by the medical scheme.

Cancer treatment
For approved cancer treatments, this benefit covers:
  • The shortfalls for cancer related treatment when a patient uses a provider that falls outside of the scheme’s network of providers
  • The co-payments imposed for specific cancer related treatment
  • The co-payments imposed once the oncology benefit limit has been reached

Amounts paid under this benefit will be subject to the overall annual limit per life insured.

Out of network hospital co-payments

If using a hospital outside of the prescribed network, the scheme will charge a co-payment. The benefit covers the co-payment that has been applied by the medical scheme.

This benefit covers:
  • Unlimited hospital stays within the NetcarePlus network
  • One hospital stay per annum up to R10 000 outside the NetcarePlus network

Amounts paid under this benefit will be subject to the overall annual limit per life insured.

Charges above sub-limits

Your medical scheme may apply a sub-limit on certain in-hospital medical procedures, prosthetic devices, length of stay in a mental health institution, rehabilitation, step-down or sub-acute facility. We will cover the shortfall once you have reached the sub-limit up to a maximum of R35 000 for each person per annum.

This benefit covers:
  • Additional cost, incurred by the insured once the sub-limit has been reached for a procedure or prosthesis.
  • The cost of an additional 5 days in a mental health institution, rehabilitation, step down or sub-acute facility.

This benefit will be subject to a maximum of R35 000 per insured per annum. Amounts paid under this benefit will be subject to the overall annual limit per life insured.

Emergency medical treatment in an Emergency Department
This benefit covers:
  • Covers the shortfall between the amount charged by the treating doctor and the amount paid by the medical aid. The difference that will be covered will be limited to 300% or 500% of your medical scheme tariff.
  • Covers the shortfall due to sub-limits applied by the scheme or co-payments for any tests, scans or appliances that are deemed medically necessary by the treating doctor in diagnosing or treating the patient
  • Covers the costs incurred in an Emergency Department, if your savings account has run out or if you have depleted your day-to-day benefit sub-limit, when treating a patient for an emergency medical condition
Cost includes
  • Doctor's consultation fees
  • Facility fees
  • Basic radiology, specialised radiology and pathology
  • Medical appliances
  • Medication administered during your consultation

Amounts paid under this benefit will be subject to the overall annual limit per life insured.

Examples of medical emergencies include
  • Injury to an accident or trauma event
  • Severe pain in the chest or abdomen
  • Choking
  • Sudden loss of consciousness
  • Suddenly not being able to walk, speak or move a portion of your body
  • Shortness of breath or difficulty breathing
  • Seizure
  • Allergic reaction
  • Persistent vomiting or diarrhea
Maternity costs

Excluded

Out of hospital specialist shortfalls

Excluded

Day-to-day costs beyond medical scheme limits

Excluded

Trauma counselling
This benefit covers the following costs due to a trauma event:
  • The difference between the amount charged by a registered counsellor or psychologist, for counselling sessions, and amount covered by your medical scheme. Your medical scheme must pay the first portion of your claim.
  • The cost of counselling sessions with a registered counsellor or psychologist once you have run out of your medical scheme savings or if you have reached your benefit sub-limit.

A trauma event is when you are:

  • A victim or a witness of a violent crime
  • Involved in an accident
  • Diagnosed with a life-threatening illness or has a loved one diagnosed with a life-threatening illness
  • Mourning the death of a loved one

The benefit is subject to a maximum of R10 000 per insured per annum. Amounts paid under this benefit will be subject to the overall annual limit per life insured.

Premium waiver

In the unfortunate event that you pass away or become totally and permanently disabled due to an accident, we will pay your NetcarePlus GapCare premiums and your medical scheme contributions for 6 months up to a maximum of R5 000 a month. This amount does not accumulate to the overall limit.

Additional 300% of the medical scheme tariff

This benefit covers:
Private ward
  • We will cover the difference between the general ward fee that is covered by your medical scheme and the private ward fee for your maternity admission. This benefit is subject to the hospital's private ward availability.
Hospital birth

If you choose to give birth at a hospital in our network, we will cover:

  • Maternity fees charged by the hospital
  • Antenatal class at our network hospital
  • The difference between the amount charged by the specialists and the amount covered by your medical scheme during your maternity stay in-hospital.
Day-to-day benefits

We will cover the difference between the amount charged by the Gynaecologist or Obstetrician and the amount covered by your medical scheme for prenatal visits.

  • When you have run out of your medical scheme savings or if you have reached your day-to-day benefit sub-limit, we will provide you with cover for:
    • Prenatal testing for high risk pregnancy, up to R25 000 for each pregnancy due to pregnancy complications.
    • Baby immunisations according to latest available government schedule of vaccinations.

When your medical scheme has paid a portion of your out-of-hospital medical specialist claim, we will cover the shortfalls for:

  • Out-of-hospital consultations.
  • Medical treatment, provided out-of-hospital.

Amounts paid under this benefit will be subject to the overall annual limit per life insured.

Once you have run out of your medical scheme savings or if you have reached your day-to-day benefit sub-limit, we extend your cover for:

  • Medical specialist consultation costs that are deemed necessary by a General Practitioner.
  • Basic dentistry
What will be covered
  • Fillings
  • Extractions
  • Specialised Dentistry
What will be covered
  • Root canals
  • Pulp removal
  • Specialised x-rays
  • Reconstructive dentistry due to an accident, trauma event or oral cancer
  • Specialised radiology or pathology that is deemed necessary by a patient’s general practitioner or specialist for treatment and diagnosis purposes

This benefit will be subject to a maximum of R20,000 per insured per annum. Amounts paid under this benefit will be subject to the overall annual limit per life insured.

The benefit is not applicable if you belong to a Hospital Plan only.

Additional 500% of the medical scheme tariff

Application complete

You have successfully completed your application for NetcarePlus GapCare 300.

Your policy documents will be sent within 48 hours to this email address:

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GapCare For Employees Gapcare For Employees Gapcare For Employees

Need NetcarePlus GapCare for your employees?

Employees with medical aid can get access to world-class medical treatment and protection against unexpected high costs beyond their medical aid limits.

More information

Further information

Need help or have questions?
Email our team at servicecentre@netcareplus.co.za or contact us on 0860 101 151

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

As part of our annual price increase, please note our new prices will take effect from 1 January 2022.