Gap cover is a separate product (NOT medical aid) regulated under the Short-Term Insurance Act and the Demarcation Regulations. It pays the shortfall between what your scheme covers (e.g. 100% DHR) and what the specialist charges (e.g. 300%). Annual benefit limit by law: R219,845.96 (2025/26). Premiums typically R150 to R600/month per family. You MUST have an underlying medical aid; gap cover doesn't pay on its own.
SA example: Specialist charges R5,400 (300% DHR). Scheme on 100% DHR pays R1,800, leaving a R3,600 gap which gap cover absorbs. Annual gap cover premium: R250 x 12 = R3,000. Pays for itself in one in-hospital event.