Insurance Biz – 14th May 2025
Healthcare needs change throughout life, but one constant remains: the risk of medical expense shortfalls. As the cost of quality medical care continues to rise and certain medical conditions become more prevalent across all age groups, the likelihood of experiencing shortfalls grows, even if you are on a comprehensive, top-of-the-range medical aid plan. Gap cover plays a vital role in protecting individuals from unexpected out-of-pocket expenses. Securing gap cover early not only ensures comprehensive protection from the cumulative effect of shortfalls, it can also help lock in lower premiums, reducing financial strain later in life.
The importance of starting early
When you’re young and healthy, it’s easy to dismiss gap cover as unnecessary. However, the reality is that accidents and medical emergencies can happen at any age. Sports injuries are increasingly likely as younger people are realising the importance of staying active, and stress-related conditions that can result in chronic illness or the need for surgical intervention are becoming increasingly common among younger individuals. In addition, many young adults are starting families, making maternity benefits a crucial consideration.
Evolving healthcare needs across life stages
In your 30s, the likelihood of developing chronic conditions such as high blood pressure, high cholesterol, and prediabetes increases. Women may experience reproductive health issues, and the risk of conditions such as breast cancer is rising among younger women. If you have children, visits to casualty due to accidents and illness become a frequent occurrence. Gap cover can help reduce financial stress by covering shortfalls in these unforeseen medical expenses.
By your 40s, additional concerns such as joint pain, back pain, hernias, kidney stones, and gallstones become more common. Cancer risks continue to rise, and while maternity benefits may no longer be a priority, the need for medical cover for active children remains.
In your 50s and 60s, chronic diseases such as heart disease, diabetes, and cancer become more prevalent, alongside musculoskeletal issues that may require costly treatments or surgery. Gap cover helps alleviate the burden of these increasing medical costs.
As you move into your 70s and 80s, the risk of serious health conditions intensifies, including cognitive decline, mobility issues, and chronic illnesses. At this stage, access to quality healthcare is essential, and the financial impact of medical expense shortfalls can be significant. Having comprehensive gap cover in place ensures that you are not faced with overwhelming out-of-pocket expenses when you need medical care the most.
The financial reality of medical expenses
Medical aid alone is no longer sufficient to cover all healthcare costs. Exposure to non-Designated Service Providers (DSPs), co-payments, and sub-limits can result in substantial medical shortfalls. These sums of money all add up and can put a serious dent in your financial stability. For example, Turnberry has a client who is 31 to whom we have paid out R333 933.91 in the past five years alone, another 47-year-old who has claimed for R468 802.67 over the past five years, a 64-year-old with claims totalling R529 598.61 and an 81-year-old with claims of R356 382.13.
When you consider these are only from a few years, the out-of-pocket expenses over a lifetime could be in the millions, so investing in a gap cover policy early on is a critical investment in your financial well-being. Gap cover provides cover up to the Overall Annual Limit (OAL), which for 2025 is R210,580 per insured person, per year, which over time also adds up to a significant amount of insurance cover.
Choosing the right gap cover policy
When selecting a gap cover policy, it’s important to consider the coverage limits, exclusions, and benefits. One significant advantage of securing gap cover early is that it helps you avoid higher premiums later in life. Once you turn 65, premiums are charged at a senior rate, which is considerably more expensive. Staying on a policy from a younger age allows you to maintain lower premiums and ensure ongoing cover, providing long-term financial benefits while ensuring you’re covered when you need it most.
Invest in your future health today
Adding gap cover to your financial planning from an early age can help safeguard your financial future and eliminate the stress of unexpected medical costs. As healthcare needs evolve, having the right gap cover policy ensures that you and your family remain protected from rising medical expense shortfalls. Consulting with a financial advisor to tailor a gap cover solution to your specific needs will provide peace of mind and long-term financial security, no matter what age or life stage you are currently in.
*Brian Harris, General Manager Operations at Turnberry Management Risk Solutions
What is Gap Cover?
https://getcovered.turnberry.co.za/app/1
Client Testimonials
Turnberry is my best Company!! We’ve been with Turnberry Gap Cover for quite a few years now. They’ve always been amazing, paying very promptly! They obviously only pay what your medical aid doesn’t cover for in-hospital only. The last few years my Wife and I have been hospitalised often, and they’ve never rejected a claim. They’ve paid more than my medical aid has paid, at a fraction of the cost! Norman
I was very impressed. I did not think it would be as easy as it was. I submitted online – it was quick and easy – even allowance made for passwords on documents. I would say that this is the first time I did claim and I was waiting for exceptions and excuses but the whole experience was very surprising and pleasant. Linda