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SA's No 1 Insurance Blog

The short answer is, it depends who you have your medical aid gap cover insurance with. Generally, the guys in the gap cover business apply a three month general waiting period before you can claim against your policy. That simply means that no claim will be paid in the first three months of the policy. “Jeez, that’s a little stiff” I hear you say. “I’m as fit as a fiddle, isn’t there a gap cover company who is prepared to take me on without imposing a waiting period?”

There actually is.

Before we get to that, let’s look at why a gap cover company might build a three month waiting period into their policy wording. It’s all about minimizing risk! They don’t want you hopping onto the insurance policy, then claiming heavily and hurting their pockets. It’s much the same as a medical aid schemes in this country. If you haven’t had prior medical aid coverage or your break in medical aid coverage is longer than 90 days, the scheme can impose a three month general waiting period before you can claim.

But I personally think the three month waiting period is a little unfair.  I mean not everyone looking to take out insurance cover of this nature is out to rip the ring out of it. For most, their intention is pure. “I don’t intend claiming, but I need the cover in case I do require it.”

Why don’t gap cover companies, or medical aid schemes for that matter, simply take members on, get them covered from day one and build in an exclusion to safe guard themselves against someone jumping onto the policy and trying to claim heavily for a certain costly procedure?

The guys at Zestlife have done just that..

On the Zestlife Medical Gap Cover policy you are covered from day one (once your first premium has been collected). That’s pretty neat. No three month general waiting period applies. There is however a waiting period for the following procedures. Just remember that the waiting periods are not applicable if the claim is as a result of an accident or injury after joining.

  • Childbirth claims will have an effective 10 month waiting period.

For the benefits below, a six month waiting period is in place and 50% of the normal benefit for the second six months after joining.

  • Joint replacements, arthroscopic procedures, spinal surgery (including spinal fusion)
  • Nasal Surgery (including sinus related), cataract surgery, hysterectomy (except for cancer diagnosed after joining), dentistry related claims, all hernia repairs and all cardiac related surgery.

In my mind that’s very reasonable. You get cover from day one, you know which procedures aren’t covered for the first six months, you know those procedures will be covered for the next six months at 50% of the benefit and  if your claim is as a result of an accident or injury after joining, the waiting period doesn’t apply.

Consider how many hundreds of potential procedures could not be paid in full by your medical aid and how few of them Zestlife has put on their waiting period list.

Kind regards,

The InsuranceFundi Team

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