Old Mutual Gap Cover Review 2026
Gap cover pays the shortfall between what your medical scheme pays a specialist or hospital and what they actually charge — it is not a medical scheme itself, and only works alongside one. This review covers Old Mutual Gap Cover, using the official 2026 policy wording (effective 1 January 2026).
What it covers
- Tariff and sub-limit shortfalls between the medical scheme rate and the actual account.
- Co-payments and deductibles your scheme applies (e.g. for certain scopes, MRIs/CT scans, or hospital admissions).
- Accidental casualty, step-down facility care, oncology shortfalls, childbirth, dental, and external medical appliances.
Premiums (effective 1 January 2026)
- Ages 18–39: R313/month
- Ages 40–59: R340/month
- Ages 60+: R416/month
Cover limits
- Overall Annual Limit: R223,000 per insured person (1 April 2026 – 31 March 2027), shared across the core benefits.
- Sub-limit shortfalls: capped at R50,000/policy/year.
- Childbirth: R15,900 per hospital event.
- Accidental casualty: R15,900/policy/year.
- Dental: R5,480 tariff cover + R5,480 co-payments/year; dental reconstruction R40,000/year.
- External appliances: R2,120/year.
- Step-down facility: R5,000/event, once a year.
- Medical scheme contribution waiver: up to R30,000 over a maximum of 6 months (if you're unable to work).
What it doesn't cover
- Anything your medical scheme itself rejects, and all Prescribed Minimum Benefits.
- Cosmetic surgery (unless trauma-related), infertility treatment, obesity treatment, and most psychiatric/psychological conditions.
- Most routine dental work (crowns, bridges, implants, orthodontics).
- A 3-month general waiting period, and a 12-month waiting period on pre-existing conditions and pregnancy.
Who underwrites it
Old Mutual Gap Cover is underwritten by GENRIC Insurance Company Limited, administered by Kaelo Risk (Pty) Ltd, and distributed by Old Mutual Life Assurance Company (SA) Limited.
Is gap cover worth it?
Gap cover makes the most sense if you're on a lower- or mid-tier medical scheme plan where specialists commonly charge above the scheme rate — particularly for planned procedures, maternity, or oncology. If you're already on a top-tier hospital plan with generous specialist cover, weigh the ~R300–R420/month premium against how often you'd actually hit a shortfall. Compare gap cover providers before you commit, and check your own scheme's specialist reimbursement rate first.
