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Welcome to Ambledown Medical Aid Gap Cover.

Ambledown QUOTES MADE EASY

Ambledown is one of the leading health insurance providers for all South African medical aid scheme members. Offering a variety of gap cover products to suit your specific needs & budget.

No Obligation Quotes & Free Broker Services

By simply filling in the form provided, one of our Gap Cover Experts will contact you via phone or email. Should you take out a Gap Cover policy, you will receive our market leading brokerage services free of charge.

You must be a medical aid member.

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2025 Updates About Gap Cover Get Medical Aid

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Page Contents

• Ambledown Gap Cover

• Watch Ambledown Video

• Ambledown Products Compared

Gap Cover 100
Gap Plus
Gap Select
Gap Supreme
LPE Advanced
Guardian

• Ambledown Waiting Periods

Ambledown Gap Cover

Family cover from as little as R 245 PM

As a private Medical Aid Scheme member, you would think that an in-hospital procedure would be covered in full, unfortunately this is not so. Consequently, most Medical Aid Schemes will only cover in-hospital services rendered by a Medical Specialist at the Medical Scheme Rate. Visit Ambledown Website >

Medical Scheme Rate (MSR) is the amount your medical aid are prepared to pay for specific treatments and procedures.

A Shortfall (Gap) is the difference medical practitioner’s charge above the Medical Aid Tariff (MST) rate for authorised in-hospital surgical and specific out of hospital procedures.

The Gap is defined as services rendered by a Medical Practitioner who charges above the MST.

To sum up, when you are insured by Ambledown Gap Cover you will receive a benefit to cover the Gap for any authorised in-hospital procedures, subject to specified limitations.

In conclusion, the Gap Cover Series offer affordable Insurance Products that provide shortfall cover for you and your immediate family.

Ambledown 2025 Updates Compared

Brochures, Benefits & Rand figures displayed are prone to change without notice, contact us for latest benefits & pricing.

Gap Cover 100

Gap Cover 100
Premium	Up to age 65: Single or Family: R 466
	Age 66 and over: Single or Family: R 706





Overall Annual Limit	R 210 580 per person per annum
Cover	500%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 500%


Co-Payment Cover	No Benefit





Sub-limit benefit	No Benefit



Oncology & biologicals	No Benefit




Additional Benefits
Cover for Day hospital/ clinic or in-room procedure	No Benefit
Primary Care	No Benefit
Specialist consultant fee	No Benefit



Emergency Room Cover - Accident and Emergency	Casualty Benefit R 11 000 per policy.
Preventative Care	No Benefit
Appliance benefit	No Benefit
Trauma Counselling	No Benefit
Accidental Death	No Benefit
Child related illness	No Benefit

Gap Premium Waiver	No Benefit
Medical Aid Premium Waiver	No Benefit
Initial Cancer Diagnosis	No Benefit
Hospital account shortfalls	No Benefit

Step down or physical rehab	No Benefit

Download Brochure

Gap Plus

Gap Plus
Premium	Up to age 65 Single or Family: R 588
	Age 66 and over Single or Family: R 771





Overall Annual Limit	R 210 580 per person per annum
Cover	300%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	Up to 300%


Co-Payment Cover	Subject to Overall Annual Limit
	Co-payment or deductibles for certain
	procedures (eg. Scopes) done in-hospital
	One penalty co-payment R15 000 limit


Sub-limit benefit	No Benefit



Oncology & biologicals	No Benefit




Additional Benefits
Cover for Day hospital/ clinic or in-room procedure	No Benefit
Primary Care	No Benefit
Specialist consultant fee	No Benefit



Emergency Room Cover - Accident and Emergency	Casualty Benefit R 11 000 per policy.
Preventative Care	No Benefit
Appliance benefit	No Benefit
Trauma Counselling	No Benefit
Accidental Death	No Benefit
Child related illness	No Benefit

Gap Premium Waiver	No Benefit
Medical Aid Premium Waiver	No Benefit
Initial Cancer Diagnosis	No Benefit
Hospital account shortfalls	No Benefit

Step down or physical rehab	No Benefit

Download Brochure

Gap Select

Gap Select
Premium	Up to age 65: Single or Family: R 693
	Age 66 and over: Single or Family: R 995





Overall Annual Limit	R 210 580 per person per annum
Cover	600%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 600%


Co-Payment Cover	Subject to Overall Annual Limit
	Co-payment or deductibles for certain
	procedures (eg. Scopes) done in-hospital
	One penalty co-payment R15 000 limit


Sub-limit benefit	Subject to Overall Annual Limit



Oncology & biologicals	Subject to Overall Annual Limit




Additional Benefits
Cover for Day hospital/ clinic or in-room procedure	No benefit
Primary Care	No benefit
Specialist consultant fee	No benefit



Emergency Room Cover - Accident and Emergency	Up to R11 000
Preventative Care	No benefit
Appliance benefit	No benefit
Trauma Counselling	No benefit
Accidental Death	No benefit
Child related illness	No benefit

Gap Premium Waiver	No benefit
Medical Aid Premium Waiver	No Benefit
Initial Cancer Diagnosis	R50 000 subject to exclusions and conditions
Hospital account shortfalls	No benefit

Step down or physical rehab	No benefit

Download Brochure

Gap Supreme

Gap Supreme
Premium	Up to age 65: R 748 per family
	Not applicable to ages 66+





Overall Annual Limit	R 210 580 per person per annum
Cover	600%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 600%


Co-Payment Cover	Subject to Overall Annual Limit
	Co-payment or deductibles for certain
	procedures (eg. Scopes) done in-hospital
	One penalty co-payment R15000 limit


Sub-limit benefit	Subject to Overall Annual Limit



Oncology & biologicals	Subject to Overall Annual Limit




Additional Benefits
Cover for Day hospital/ clinic or in-room procedure	No benefit
Primary Care	No benefit
Specialist consultant fee	No benefit



Emergency Room Cover - Accident and Emergency	R 11,000.00
Preventative Care	No benefit
Appliance benefit	No benefit
Trauma Counselling	No benefit
Accidental Death	No benefit
Child related illness	No benefit

Gap Premium Waiver	6 months subject to conditions
Medical Aid Premium Waiver	6 months subject to conditions
Initial Cancer Diagnosis	R50 000 subject to exclusions and conditions
Hospital account shortfalls	No benefit

Step down or physical rehab	No benefit

Download Brochure

LPE Advanced

LPE Advanced
Premium	Up to age 65: Single or Family: R 460
	Age 66 and over: Single or Family: R 682





Overall Annual Limit	R 210 580 per person per annum
Cover	600.00%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 600%


Co-Payment Cover	No Benefit





Sub-limit benefit	No Benefit



Oncology &	No Benefit
biologicals



Additional Benefits	R100 000 Cover for the following listed Procedures:
	Impacted Teeth for minors under 18 years or
	Reconstructive Surgery due to an accident
	Functional Nasal Surgery
	Joint Replacement Surgery
	Oesophageal Reflux and Hiatus Hernia Surgery
	Varicose Veins Surgery
	Back and Neck Surgery
	Cochlear Implant, Auditory Brain Implant and
	Internal Nerve Stimulator Surgery including the Device
	Bunionectomy/Arthroscopy/Skin disorders
	Removal of tonsills and adenoids
	Grommets
	Arthroscopy

CASUALTY BENEFIT	There is a casualty benefit of R11 000
PREMIUM WAIVER BENEFIT	No benefit
CANCER INITIAL DIAGNOSIS BENEFIT	No benefit

Download Brochure

Guardian

Guardian
Premium	Up to age 65: Single or Family: R 245
	Age 66 and over: Single or Family: R 348





Overall Annual Limit	R 210 580 per person per annum
Cover	No Benefit






Co-Payment Cover	Subject to Overall Annual Limit
	Co-payment or deductibles for certain
	procedures (eg. Scopes) done in-hospital
	One penalty co-payment R15 000 limit


Sub-limit benefit	Subject to Overall Annual Limit



Oncology &	Subject to Overall Annual Limit
biologicals



Additional Benefits














CASUALTY BENEFIT	R 15,000.00
PREMIUM WAIVER BENEFIT	6 month subject to conditioins
CANCER INITIAL DIAGNOSIS BENEFIT	R50 000 subject to exclusions and conditions

Download Brochure

Ambledown Gap Cover Waiting Periods

3-Month General Waiting Period

There is a general 3-month waiting period where no benefits will be payable for treatment received. During this three-month period, you will be covered for treatment as a result of an accident.

12-Month Pre-existing Waiting Period

During the first 12 months, a pre-existing clause applies. This clause excludes claims for any treatment or advice that has been received in the 12 months prior to the start of the policy. After the membership has exceeded 12 months, then all benefits are payable regardless of the date the illness or injury occurred.

Welcome to Ambledown Medical Aid Gap Cover.