Gap Cover

Top up your Medical Aid with GAP cover

Members of any medical scheme can be insured against medical expense shortfalls through a range Gap Cover options

 

Who’s Covered

  • Cover is available to members of all medical schemes.
  • Cover applies to the main medical scheme member and all family members listed as their medical scheme dependants.
  • Single medical scheme members under the age of 55, as the only life insured by the policy, qualify for a lower monthly premium.
  • An over 65 premium applies if the main medical scheme member or any of their dependants are 65 years or older.
  • There is no maximum entry age restriction.

In-hospital Cover

In-hospital Medical Expense Shortfall Cover = (combined doctor and specialist charges up to but not exceeding up to 5 times the medical scheme tariff) minus (the greater of either the medical scheme’s contribution towards these charges or the medical scheme’s stipulated tariff amount for these charges).

Medical Scheme Co-payment Cover

Full cover for upfront co-payments that are expressed by the medical scheme in Rand amounts as opposed to a percentage, and charged to their members for hospital admissions, scans and certain surgical procedures.

Non-network Co-payment Cover

Full cover for upfront co-payments that are expressed as a Rand amount or as a percentage, as charged by medical schemes to their members for using a non-network hospital or medical practitioner. This cover is subject to a maximum of R8 000, limited to one claim for each policy each year