How to Claim My Gap Insurance Cover from SARS

By Dave Nyam •  Updated: 02/04/24 •  6 min read

Gap insurance is a necessary form of insurance for those living in South Africa, and it’s essential to understand how to claim your gap insurance coverage from the South African Revenue Service (SARS).

This blog post will discuss gap insurance, how it works in South Africa, and when and how you can claim. We’ll also discuss what gap cover covers and how long SARS typically takes to pay the claim. Read on to learn more about gap insurance coverage from SARS!

How Do I Claim My Gap Insurance Cover?

If you need to claim your gap insurance coverage from SARS, you must provide proof of the coverage gap. This proof could include medical bills, receipts, or other evidence of expenses incurred.

SARS will then review your documents to assess if your claim is valid. You must also provide proof of payment for the entire premium paid to the insurer.

Once SARS reviews and accepts the documents, you can apply for a claim form. You can find this form online or at your local SARS office. Fill out the doc, sign it, and submit it to SARS.

After your claim has been approved, SARS will pay the gap insurance cover amount directly into your bank account. Depending on the complexity of your claim and the amount, you may be required to provide further information or documents before they process the claim.

Can You Claim Gap Cover From SARS?

You can claim gap cover from the South African Revenue Service (SARS). A gap cover is a form of insurance that helps you pay for medical costs not covered by your medical scheme. It provides additional coverage when there are gaps between what your medical scheme will pay out and what your medical provider charges.

To claim gap cover, you must register with SARS and submit the required documents to support your claim. These documents may include proof of identity, proof of address, and proof of medical scheme membership. It is also vital to provide an itemized invoice or bill from the medical provider detailing the amount of the gap you want to claim.

Once you submit all the required information, SARS assesses your claim and decides whether to pay out the gap cover. Generally, the process takes about four weeks to complete. However, in some cases, it may take longer due to administrative delays.

How Does Gap Cover Work In South Africa?

Gap cover is a type of insurance policy that helps bridge the gap between what a medical scheme covers and what an individual needs to pay for their medical bills. Gap cover is available to medical scheme members, providing them with additional benefits over and above what their medical scheme covers. This cover helps to make medical treatments more affordable and accessible.

Although certain conditions may apply, gap cover is available to individuals and families. However, some gap-cover policies limit how much they will pay per year, so it’s vital to understand what your policy covers before making a claim.

It’s also important to remember that gap cover policies come with terms and conditions. So make sure you read these carefully before signing up for a policy.

What Does Gap Cover Cover?

Gap cover is a type of insurance coverage that pays the difference between what medical aid schemes pay out and what you are liable for in the event of hospitalization or medical treatment. It can also cover any unpaid balances due to hospitalization or treatments. Gap cover usually covers both in-hospital and out-patient treatments and can also cover any shortfall in medical costs not covered by your medical aid scheme.

Gap cover policies can also provide additional benefits such as unlimited overall limits, the double payout for cancer treatments, cash payments for waiting periods, and day-to-day benefits like medical costs. It is essential to check with your insurer to make sure that you know precisely what your policy covers.

How Long Does Gap Cover Take To Pay Out?

Gap cover payouts can vary depending on the policy and the insurer. But generally speaking, SARS can settle the claim within a few weeks.

Claiming gap cover usually involves submitting all relevant documents to the insurer, who will assess your claim. After assessing your claim, you should receive the payout within a few weeks.

It is important to remember that each insurer has different processes when it comes to claiming gap cover, so make sure to read through the policy terms and conditions before making a claim. Additionally, if you have any questions or concerns about the process, you should contact the insurer directly to clarify any queries.

When Can You Claim Gap Cover?

Gap cover can be claimed in certain situations depending on the specific policy and insurer. Generally speaking, you can claim the gap cover after a few years have passed and you have paid your premium in full.

Depending on the type of gap cover you have taken out, you may also claim gap cover when you have made use of services that are not covered by your regular medical insurance. These services include treatments and procedures considered more expensive than your medical insurance plan offers.

It is important to note that gap cover policies vary from one insurer to the next, so it is essential to review the terms and conditions of your particular policy carefully before making a claim. To ensure that you are eligible for a claim, you should also ensure that you are up-to-date with all premium payments, as most insurers will not accept claims from individuals who have missed payments.

Furthermore, it is vital to understand that gap cover does not cover pre-existing conditions or any costs associated with elective procedures such as cosmetic surgery. As such, if you want to claim these services, you will need to do so through other means, such as your medical scheme or private insurance policy.

Conclusion

Gap cover from SARS can be invaluable protection against unexpected financial losses. In addition, it provides peace of mind and financial security.

Claiming your gap insurance coverage from SARS is a simple process that should take minimal time to complete. Understanding how gap cover works, what it covers, and when you can claim it is essential in making the most of your policy and ensuring you are fully protected.

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