When can you claim?
• The waiting periods all start on the same ‘Join Date’ as specified in the certificates.
• There is no general 3 month waiting period.
• There is however a 10 month condition specific waiting period for any Gap Cover policy if they relate to any of the conditions as set out in our brochure, on pages 12 – 16. Click here to download the brochure
• There is a 9 month waiting period for Cancer related claims for Policyholders previously diagnosed with cancer (prior to membership) and who are currently in remission.
• Policyholders should prove that they have been in remission for two or more consecutive years.
• No claims relating to pre-existing medical conditions that may lead to hospitalisation will be covered within the first 6 months of membership.
• However, claims for conditions received within the 6 month and 10 month waiting period may be reviewed by medical management to identify pre-existing conditions.
When are you not covered by your Gap Cover Policy?
• When you have reached the annual aggregate limit of R158 000 per insured person per annum (except for the accidental death and policy extender benefits).
• Where you have reached any of your benefit limits
• Where you are not being admitted into hospital
• Where your claim is unrelated nor falls under the option benefits.
• To see the full list of terms and conditions please refer to page 14 of our booklet/brochure, which you can download Here.
It is the policyholder’s responsibility to ensure that TRA receives claims within 3 months from the day the claim was processed and paid by the medical aid scheme and to make sure that we have the correct banking details into which the claim must be paid.
To find out more information about TRA’s Gap Cover product options, contact your intermediary or go to our website
