As healthcare costs continue to rise in South Africa; one uncomfortable truth is becoming clear: medical aid shortfalls are no longer the exception; they’ve become the rule.
At Kaelo, we’ve seen the average gap claim climb to R8,800, with some cases reaching as high as R201,000.
To put that into perspective, that’s the equivalent of 18 years of repayments for the average medical aid member. For most employees, this is a financial burden they simply cannot afford.
This raises a tough question for business leaders, HR professionals, and intermediaries alike: How do we protect employees from devastating medical expense shortfalls without creating unnecessary resistance or administrative headaches?
Why the Traditional Approach Isn’t Working
Historically, businesses have had two choices when it comes to gap cover:
- Voluntary enrolment – Leading to a low uptake.
- Compulsory membership – Resulting in high resistance from HR and employees.
Neither approach addresses the real issue: the growing financial vulnerability of employees.
Introducing A Smarter Path: The Decline Gap Offer
Kaelo introduced the Decline Gap Offer, a model that reframes the conversation around choice and
protection.
All employees on medical aid are automatically offered gap cover at the best possible group rates, but they retain the option not to participate. This approach removes the need for formal policy changes while still providing every employee access to protection they could not secure individually. The results speak for themselves:
- 94–97% participation, with most declines coming from those already covered under a spouse’s plan.
- Signed, documented advice records that reduce liability for employers and intermediaries.
- Stronger employee trust, as businesses demonstrate genuine care for employee well-being.
For forward-thinking organisations, this approach delivers:
- Minimal disruption – no policy change headaches.
- Reduced costs – existing gap cover members enjoy lower premiums.
- Cultural alignment – employees feel protected, not forced.
- Business resilience – safeguarding employees against crippling medical expense shortfalls strengthens loyalty and engagement.
The Bottom Line
The gap between what medical aids pay and what employees must cover grows every year. Ignoring it isn’t an option. By rethinking how gap cover is introduced, companies can protect their workforce, ease HR complexity, and reinforce trust, all the while keeping choice at the centre.
At Kaelo, we manage the full rollout process from communications to intermediary coordination, so employees get immediate cover, with no underwriting, no waiting periods, and no unnecessary delays.
In today’s healthcare environment, the real question isn’t if employees need gap cover — it’s how soon you can give them the choice to have it. By making protection accessible, affordable, and optional, businesses empower their people to thrive with confidence.
Contact your Intermediary today for more information about the Decline Gap Cover Campaign.
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