James White, Director Sales and Marketing
The Business of Money – 14th September 2026
Many South Africans know that medical aid is essential if they want affordable access to private healthcare, but there is still a misconception that having medical aid means they are adequately covered. In reality, medical expense shortfalls, co-payments and sub-limits are increasingly common, even on top-tier plans. This means that gap cover is no longer a ‘nice to have’ extra but an essential tool that helps brokers protect their clients from the financial impact of medical expense shortfalls. In addition, gap cover offers another stream of annuity income through recurring commission structures. Helping clients to understand how their medical aid works, where there may be shortfalls and why gap cover is important, will be key in leveraging this largely untapped opportunity.
Overlooking the opportunity
Underinsurance is not limited to a single demographic; it exits across the board. Younger clients in particular are an important market for gap cover because they have the potential to become long-term clients, ensuring an ongoing revenue stream from commission. While they may believe they do not need gap cover because they are young and healthy, the reality is that accidents and illness do not discriminate by age.
Older clients may also be underinsured because affordability becomes a greater consideration, particularly as medical aid premiums increase. At the other end of the spectrum, some clients believe they have sufficient financial resources to pay additional healthcare expenses themselves. However, many people underestimate how much private medical treatment can actually cost and how significant medical expense shortfalls and co-payments can be.
Medical expense shortfalls account for nearly 80% of Turnberry’s claims, and oncology claims have doubled in the past seven years. Co-payments of more than R40,000 are no longer rare and, in some cases, are required upfront before a procedure. Heart conditions that require surgery can easily result in shortfalls of nearly R200,000 from a single event. In less than 10 years, multiple Turnberry clients have had claims totalling more than R400,000. Even something as simple as a trip to the emergency room as a result of a fall can cost thousands of rands.
Education is more effective than selling
Educating clients on the way medical aids pay for treatment and explaining the potential shortfalls in real-world financial terms is essential in helping them understand the need for gap cover and the financial protection it provides. Brokers need to take the time to help their clients understand the difference between medical aid and gap cover, where they may have co-payments, how sub-limits work and where shortfalls could occur.
Leveraging the gap cover opportunity is not about selling harder. This discussion should be framed around the needs of the client rather pitching a product. It is also important to simplify the complex and often confusing terminology used by medical aids and, as a result, by gap cover providers. Most clients will either have experienced a hospital event themselves or know someone who has. These familiar experiences can make the risk easier to explain and help clients understand why the additional premium provides valuable financial protection.
Building meaningful recurring income
Adding a gap cover policy on top of medical aid creates another layer of recurring commission for as long as a member continues paying their premium. The commission on a gap cover policy is typically 20%, so, for example, if the premium is R200, a broker will earn R40 a month. This may not seem like much, but when you scale that R40 across 200 clients, it becomes a meaningful amount of money. Gap cover is also significantly less admin-intensive than medical aid. Beyond putting the appropriate cover in place, a broker’s ongoing role generally involves providing advice when required, assisting with claims submission and reviewing cover regularly.
It is also important for clients to understand that using a broker does not increase the cost of their gap cover. Commission is built into the premium, so the client pays the same premium whether the cover is arranged through a broker or independently. When an existing client takes out gap cover independently, the broker misses the opportunity to earn recurring commission on cover the client already needs and pays for.
Making gap cover part of every medical aid conversation
Despite the ever-increasing cost of medical aid premiums and private healthcare, clients frequently underestimate where medical expense shortfalls may occur and how much an unexpected healthcare event can actually cost. Brokers are in the ideal position to help their clients identify these gaps because they are already providing advice on medical aid. Gap cover needs to become part of this conversation.
Brokers should understand their clients’ circumstances, healthcare needs and budgets, recommend an appropriate medical aid option, and explain where medical expense shortfalls may still arise and how gap cover can help address them. By tying in gap cover to conversations around medical aid, brokers can help clients put more complete healthcare protection in place while also building a valuable source of recurring income within their existing client base.
The untapped gap cover opportunity advisers are missing – The Business of Money
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Client Testimonials
All round I can honestly say that it was nothing short of a very positive experience. I submitted a claim for a very large upfront copayment to the hospital (R23,700) for a joint replacement operation. The staff member dealing with my portfolio was friendly and very helpful in putting my mind at ease. My operation was on 23rd June 2026 and I received settlement of the claim on 9th July 2026. All my queries were dealt with swiftly and professionally. I can therefore wholeheartedly recommend Turnberry as a gap cover. All my queries were dealt with swiftly and professionally. I can therefore wholeheartedly recommend Turnberry as a gap cover. Marianne – July 2026
My claim experience with Turnberry was very good – I consulted my broker who guided me promptly and responded efficiently to my questions. He shared a guideline doc – a really useful graphic on how to claim. Very good, clear document. I would say to anyone considering Turnberry Gap Cover – that it was a very good gap cover in terms of monthly cost, efficiency of claims, support during the claim process. Anon – July 2026
Turnberry have been absolutely amazing. Mitze was the consultant on our claim and she went above and beyond to assist us. The first claim was submitted online, thereafter when I tried to submit the form for another claim, the online form was not available. However, all claims were emailed to Mitze who ensured they were processed. If you want exceptional service and a hassel free claim process, use Turnberry. Anon