Origin Gap Cover series provides six gap cover options for all age groups, with age-based pricing that makes quality coverage more accessible to younger South Africans.
Ambledown Financial Services has launched the Origin Gap Cover series, offering six gap cover plans with age-based pricing starting at R130 per month for individuals aged 18 to 27 years. With the introduction of a wider set of age bands, younger members benefit from more affordable options, while older members can choose more comprehensive cover if they prefer.
Gap cover products pay the shortfall between what medical practitioners charge, for in-hospital treatment or procedures and defined out-patient procedures, and what medical schemes reimburse, protecting members from unexpected out-of-pocket costs. Gap cover is not a medical scheme and does not replace medical scheme membership.
Note: While the age band is designated as 0 to 27 years, policyholders must be 18 years or older to enter a contract. A person under 18 may be the insured person but cannot be the policyholder.
Age-based pricing addresses cross-subsidy concerns
The Origin Gap Cover series uses age-based premiums that reflect members' healthcare risk profiles. Younger members, who typically earn less and use fewer healthcare services, pay lower premiums than older members.
"Ages 0 to 27 years will now have access to ultra-affordable gap cover," says Tiago de Carvalho, CEO of Ambledown Financial Services, who launched South Africa's first gap cover product 21 years ago. "At the same time, members who need more comprehensive coverage can access our most extensive plans."
The Origin Gap Cover series features six plans designed to meet diverse healthcare needs and budgets. The range includes four Standard Cover options – Phi, Alpha, Sigma, and Omega – alongside two Network Option (LPE) plans, Echo and Nova, providing members with flexibility to select coverage that aligns with their specific requirements.
The Origin Gap Series introduces accessible age-based pricing, with entry-level cover starting from R130 per month. The range includes six distinct plans – from essential gap cover to comprehensive protection with additional benefits such as cancer cover and travel insurance – allowing members to select coverage that aligns with their needs and budget.
Existing Ambledown clients retain their current pricing structures, while new members joining Origin Gap Cover series are priced according to their age band.
De Carvalho says: “What we have done is create regulatory honesty and consumer empowerment. We have built a new brand – no baggage, just transparency and fair, age-based pricing. If you joined our gap cover in 2005, you might still be paying low legacy rates. But if you join now, our new product range prices you fairly and rewards you for the most advanced cover.”
Six plans eliminate redundant coverage
The six-plan structure allows members to select coverage that complements their existing medical scheme benefits rather than duplicating protection they already have.
The Origin Gap Cover series plans benefits include:
- Phi: Gap cover up to 200% of medical scheme rate + Out-patient specialist consultations
- Alpha: Gap cover up to 600% of medical scheme rate + Out-patient specialist consultations
- Sigma: Gap cover up to 600% of medical scheme rate + Out-patient specialist consultations + Casualty ward benefit + Co-payment cover + One penalty co-payment + Travel insurance up to R2m (medical emergencies, trips ≤90 days)
- Omega: All of Sigma plan benefits + Sub-limit cover + Cancer cover + Dread disease (severe illness) benefit + Premium waiver benefit (once-off 6 months medical scheme + gap cover premiums)
- Echo: Gap cover up to 600% of medical scheme rate + Out-patient specialist consultations + Casualty ward benefit + Listed Procedure Enhancer (LPE) (including medical expenses shortfall related to 13 defined procedures)
- Nova: Gap cover up to 600% of medical scheme rate + Out-patient specialist consultations + Casualty ward benefit + Co-payment cover + One penalty co-payment + LPE (including medical expenses shortfall related to 13 defined procedures.
Important: All benefits are subject to an annual limit of R219,845 per insured person per year, or any higher amount published by the Regulator during the year.
The Origin Gap Cover series design centres on two key principles: affordability and needs-based coverage. De Carvalho explains the philosophy: “The principle is simple: younger, healthier members require affordable protection against unexpected medical costs. Members with regular specialist visits or ongoing health conditions need comprehensive coverage that matches their actual healthcare usage. You choose the plan that fits your life stage and health needs.”
This modular approach enables brokers to match Origin Gap Cover plans with their clients' existing medical scheme benefits. The six-plan structure allows brokers to recommend coverage levels that complement members' current protection without duplication.
Technology platform supports distribution
Ambledown has also created a broker portal where the broker can understand what is happening to any of their clients at any point in time – be it claims, membership records or premium history. Brokers can use this tool to get quick electronic applications through to members, whether one-on-one or emailing an entire employee group. They can follow those sales to check their status.
The broker portal provides comprehensive tools to streamline application processing from start to finish. Brokers gain access to powerful analytics presented through intuitive visual dashboards, enabling them to track member sign-ups, conduct needs analysis, and monitor campaign performance in real-time. The platform supports multi-channel marketing initiatives, allowing brokers to seamlessly integrate social media campaigns and email outreach all within a single, integrated platform.
De Carvalho says: “We believe the broker portal will significantly improve how application processing and client management is executed. Since 2018, we have focused on digitisation and that includes AI. We are introducing AI that assesses gap cover claims, and we will continue to expand our abilities to drive further digital innovation. The financial sector needs to embrace technology and ensure it is a core strength to be competitive in the future.”
Market expansion through strategic innovation
De Carvalho says the Origin Gap Cover series means those who really need gap cover will have access to comprehensive products. Younger age groups benefit from more accessible entry-level pricing and mitigate risk at an affordable price. “A myriad of young people will suddenly have access to gap cover at an affordable rate and people who really need more cover will migrate to our comprehensive plan. As an interactive, digitised organisation, we will offer solid service and quick claims turnaround times, plus accessibility to electronic tools for both members and brokers.”
He says: “I would like to see 10,000 new members by the end of next year – that is realistic. If we see 20,000, we know we have made a real difference.”
The Origin Gap Cover series combines 21 years of market experience with next-generation technology to deliver accessible and innovative healthcare coverage for South Africans at every life stage. The Origin Gap Cover series is now available through registered brokers.
Ambledown Financial Services is an authorised Financial Services Provider No.10287. Gap Cover is not a medical scheme and the cover is not the same as that of a medical scheme. Gap Cover is not a substitute for medical scheme membership.
The Origin Gap Cover series is administered by Ambledown and underwritten by Guardrisk Insurance Company Limited (GICL) A Licensed Non-Life Insurer, Reg. No. 1992/001639/06, FSP No. 75.
