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FA News – 18th February 2026<\/p>\n
As medical expense shortfalls rise, specialist fees climb beyond scheme tariffs, and co-payments become routine rather than the exception, gap cover consistently proves its worth.<\/p>\n
The real value of gap cover is often evident in the long-term: real claims data show that even members who seldom claim eventually face medical costs that far exceed their monthly premiums. With increasing claim frequency, escalating expenses, especially related to oncology and surgery, and high-value claims reaching the Overall Annual Limit (OAL), gap cover has become one of the most effective ways to safeguard your finances over time.<\/p>\n
Why medical shortfalls are rising faster than premiums<\/strong> This means consumers face two financial pressure points: rising co-payments and increasing shortfalls on specialist accounts. Today, co-payments of more than R40,000 are no longer rare and, in some cases, are requested upfront before a procedure may go ahead. Shortfalls and co-payments together account for around 75% of Turnberry\u2019s claims – rising to 80% in certain provinces – demonstrating how widespread these gaps have become.<\/p>\n At the same time, claim frequency is rising. Oncology claims have doubled over the past seven years, driven by technological advancements and more effective treatment programmes that require ongoing interventions. Casualty claims for illness after hours now make up around 10% of our total claims, affecting families across all life stages.<\/p>\n The long-term value becomes clear in real claims data<\/strong> Lifetime claims data tells an even clearer story of value over time. Our top five lifetime claimants have received between R441,575.13 and R678,891.07 in benefits. These figures represent ordinary people experiencing typical health journeys: surgery, scopes, oncology, complications, specialist consultations and ongoing treatment cycles. Gap cover turned each of these potentially devastating financial burdens into manageable events.<\/p>\n Even smaller, more frequent claims accumulate. A shortfall of R20,000 in one instance and R12,000 in another, particularly after multiple procedures, can quickly exceed the annual cost of premiums. This is why even low-claiming members often find that, over several years, the value they receive surpasses what they have paid.<\/p>\n The right cover matters<\/strong> It is also important to make sure your gap cover works properly with your medical aid plan. If your medical aid does not cover a procedure at all, gap cover will not step in to fill that gap. A qualified broker can help you navigate these differences and choose a policy that supports your specific medical aid structure, so you are not surprised by avoidable expenses.<\/p>\n Gap cover is a long-term financial safety net<\/strong> To ensure that your cover delivers maximum value over time, speak to your broker about securing the right gap policy for your needs.<\/p>\n Brian Harris – GM Operations\u00a0Turnberry Management Risk Solutions<\/p>\n
\nMedical inflation continues to outpace salary growth, and medical schemes are restricted in how much they may increase premiums each year. To keep plans affordable, many schemes have introduced more co-payments, tightened sub-limits and maintained cover at 100% or 200% of scheme rates even as specialist fees climb far higher. In many high-demand fields, such as oncology, orthopaedics and neurosurgery, practitioners routinely charge well above these tariffs.<\/p>\n
\nWhen comparing premiums with actual claims paid over time, the long-term value of gap cover is unmistakable. In 2025 alone, several claims have reached the OAL of R219,845.96, including cases of cervical disc disorders with myelopathy, persistent atrial fibrillation, spinal stenosis in the lumbar region, acute ischaemic heart disease and maxillofacial cancer. These are events that can affect individuals with no prior chronic conditions, proving that major medical shortfalls are not confined to any one age group or profile.<\/p>\n
\nChoosing the right gap product is essential, because different plans offer very different levels of protection. Some options include extensive co-payment benefits, which can be especially helpful when co-payments run into the tens of thousands of rands and are required before treatment can begin. The scope of your benefits can influence both the cost of care and your ability to access it without delay.<\/p>\n
\nAs medical costs rise, and as shortfalls and co-payments grow both in size and frequency, gap cover continues to demonstrate its long-term value. It protects you not only in the catastrophic moments, but also in the ordinary, unpredictable medical events that all families face at some point.<\/p>\n