The gap is covered in instances where there is a shortfall between what service providers charge and what your medical aid scheme will cover. No more stress needed here. We have three product options which have been tailor-made to suit your needs.

Like most people, you have a medical aid to give you peace of mind that if you need medical care for any reason – be it through accident or illness – your bills will be taken care of. After all, who needs to add financial worry to the stress of being hospitalised?

And… like most people, you probably assume that if you have a medical aid, then you’re 100% covered. Unfortunately, this is not always true – which is why you need gap cover to ensure that you don’t receive a huge hospital bill if there’s a shortfall between what the doctors charge and what your medical aid will pay.


Benefits


Vital Cover Plus


Super Cover Plus


Absolute Cover Plus

GAP COVER ANNUAL LIMIT* R150 000 in aggregate per
insured person per annum*

R150 000 in aggregate per
insured person per annum*

R150 000 in aggregate per
insured person per annum*

GAP COVER PERCENTAGE* 700%* 700%* 700%*

CO-PAYMENTS / DEDUCTIBLES*:

DSP's

(Voluntary use of designated service
provider networks)

None Up to R50 000 per
policy per annum*
Unlimited*

CO-PAYMENTS / DEDUCTIBLES*:


NON-DSP’s
(Voluntary use of non-designated
service provider networks)

None None 2 Co-payments /
deductibles per policy per
annum to a combined
maximum of R12 000*

SUB-LIMITS*:


Prostheses

None None Up to R90 000 per policy
per annum. Up to
R30 000 per event.*

SUB-LIMITS*:

MRI / CT scans



None


None

2 MRI or CT scans up to
R4 000 per scan*

CASUALTY BENEFIT*

R5 000 per policy per annum* R7 500 per policy per annum* R15 000 per policy per annum*


ONCOLOGY GAP BENEFIT*

(Subject to medical aid approved
treatment plan being covered up to
scheme tariff and within annual
scheme oncology limit)

Up to an aggregate of
R150 000 per insured
person per annum*

Up to an aggregate of
R150 000 per insured
person per annum*

Up to an aggregate of
R150 000 per insured
person per annum*


ONCOLOGY EXTENDER BENEFIT*

(Includes ANY costs above annual
scheme oncology limit but subject to
scheme covering up to this limit)


None

None

Up to R120 000 per
policy per annum*


ACCIDENTAL DEATH
Insured / Spouse

R3 000

R4 000

R5 000


ACCIDENTAL DEATH
Dependant

R1 500 R2 000 R2 500


POLICY EXTENDER
(Additional 6 month gap cover
premiums covered upon death of
policyholder)

R930 R1 140 R1 794

Monthly
Premium

R155
per family
R190
per family
R299
per family

*SUBJECT TO THE AGGREGATE GAP COVER ANNUAL LIMIT OF R150 000 PER INSURED PERSON PER ANNUM.
Ward fees, theatre fees, medicines and materials are excluded. No claims below R100 will be processed.

Terms and conditions apply. This matrix does not constitute advice. Consult your intermediary for guidance in choosing the product that is right for your needs.
Prescribed Minimum Benefits (PMB’s) are covered.

 

         

 

All of the above Gap Cover policies:

  • Provide benefits for members and their dependants (spouse and/or child/children) who are covered on a registered medical aid scheme. You can only be on two different medical aid policies  and one Gap Cover if you are a legally married couple  (not just common law or any other definition).
  • Have no entry age limit.
  • Allow immediate benefits for all policyholders except for a limited list of specific conditions and/or procedures. (There is no general 3 month waiting period!)
  • Provide immediate cover for many procedures including: All emergency procedures, sterilisations, vasectomies, tonsillectomies, appendectomies, gall bladder removal, procedures and conditions not specifically excluded where a medical aid has failed to meet its obligation in this regard.
  • Cover Prescibed Minimum Benefits (PMBs) where a medical aid has failed to meet its obligations in this regard.
  • Are not medical aid schemes. The cover is not  the same as that of the  medical aid scheme. The cover  is not a subsitute for a medical scheme membership.
  • Are subject to the aggregate gap cover annual limit  of R150 000 per insured person per annum.



TERMS AND CONDITIONS
A full list of terms and conditions can be viewed here.

Contact us for more information about Gap Cover today.