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Co-Payments explained

You do the responsible thing. You’re on medical aid. You pay your contributions every month. You get the referral, book the procedure, arrive at the hospital, and trust that everything’s in place.
Then the bill comes.

And there it is: a co-payment.

What is a Co-payment?

A co-payment is the part of a medical cost that your medical aid expects you to pay yourself. It may apply to certain procedures, hospital admissions, scans, specialists, or situations where the cost of your treatment is more than what your medical aid covers.


Why does it exist?

Co-payments exist because medical aid plans have rules, limits, and agreed rates. Sometimes there's a shortfall between what your healthcare provider charges and what the medical aid pays. Sometimes your plan requires you to pay a set amount for a specific treatment or service.

Either way, it can feel the same: an unexpected cost at a time when your focus should be on getting care.

That's why it helps to understand your cover before you need it.


What can you do about it?

A few simple steps can make a difference. Before treatment, ask your medical aid whether a co-payment applies. Request a quote from your provider. Check whether you need pre-authorisation. Find out whether using a designated service provider could reduce your out-of-pocket costs. And keep your documents, invoices, and medical aid statements together in case you need to submit a claim.


Gap cover can also help reduce the pressure of certain shortfalls, depending on your policy terms, limits, and exclusions. The Unlimited's Gap Cover Premium includes co-payments and sub-limitation cover.

Don't wait until an unexpected bill arrives to understand your options.

Get Gap Cover now!

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