AS Brokers · Health & Integration
Medical Aid & Gap Cover
The Health to Enjoy the Wealth You Build
In South Africa, registered medical schemes fall under the Medical Schemes Act and oversight distinct from typical FAIS long-term products. Gap cover is usually a short-term insurance policy that pays toward in-hospital shortfalls when specialists charge above scheme tariff—subject to policy caps, waiting periods, and insurer rules. We help you compare options in plain language; we do not promise scheme benefit outcomes or claim approvals.
FSP 17273 · Scheme rules and PMBs apply per scheme
Medical schemes: what to compare
Scheme options differ by network, savings accounts, day-to-day rules, and chronic medicine programmes. Prescribed Minimum Benefits (PMBs) exist for certain conditions within scheme frameworks—but practical access still depends on scheme formularies, designated service providers, and pre-authorisation. Always read the scheme’s rules each year; benefits and contributions change.
We assist with structured comparisons; final membership is between you and the scheme you select.
Gap cover: how it fits
Gap policies are not substitutes for scheme membership for in-hospital care; they work alongside your scheme, within annual caps introduced under regulations that limit gap exposure relative to scheme benefits. Waiting periods for pre-existing conditions, oncology sub-limits, and co-payment riders vary—disclosure at application is critical to avoid later repudiation.
If you change schemes, review gap alignment; combination mismatches are a frequent source of frustration.
Integration with risk and income planning
Executives often carry severe illness and income protection alongside medical benefits. We map overlaps so you are not paying twice for the same risk event without knowing it, or leaving oncology shortfalls uncovered because products were bought in isolation.
Wellness and day-to-day costs
Day-to-day spend, dental, and optical are often self-funded or scheme-specific. We can discuss budgeting and alternative structures that fit your tax and cash-flow picture—without presenting unlicensed “health insurance” as a magic substitute for a medical scheme where the law expects scheme membership.
Regulatory note
Medical schemes are regulated by the Council for Medical Schemes (CMS). This page summarises general distinctions only; it is not a substitute for scheme brochures or insurer policy books. FSP 17273 for intermediary services within our licence categories. Disclosures.