Absolute Cover Plus is TRA’s premium gap cover offering that works hand in hand with your registered medical aid scheme. It covers the difference between what your medical aid pays and what healthcare providers charge for in-hospital procedures, specialist consultations, and cancer treatment.
This gap cover product includes Casualty cover, Co-Payment cover, Sub-Limit cover, and specialised oncology treatment benefits, including the Oncology Gap Benefit, Oncology Co-Payment Benefit, and Oncology Extender cover. More recent enhancements include the Global Fee Benefit, Breast Reconstruction Surgery shortfall benefit Oncology ‘New tech’ benefit and the maternity private ward rate benefit.
Please note that Gap Cover is not a substitute for medical aid; rather, it is a supplementary health insurance policy for medical aid members.
Key Benefits & Features (Updated for 2025)
- Core Gap Cover:
- Above Tariff Cover: Covers up to 700% of medical scheme tariff for in-hospital shortfalls (up to R219 845 per insured person per annum)
- Shortfalls on Specialist Consultations: 4 consultations per policy per annum (up to R500 per consult) for shortfalls before in-hospital procedures
- Emergency Medical Services (Ambulance): Unlimited shortfall cover for out-of-network emergency services (subject to aggregate annual limit)
- Hospital Procedure Cover:
- Co-payment Cover: Unlimited co-payments for diagnostic and endoscopic procedures when using designated networks (subject to aggregate annual limit)
- Sub-limit Benefit – Internal Prostheses: Unlimited coverage for sub-limits, up to R68,250 per event
- Global Fee Benefit: Covers shortfalls when providers charge above negotiated global fees, up to R25,200 per policy per annum
- Casualty & Emergency:
- Casualty Cover: Emergency visits to casualty units up to R23,100 per policy per annum (accidents only, extended coverage for children under 8)
- Oncology Benefits:
- Oncology Gap Benefit: Covers shortfall for medical aid approved oncology treatment (unlimited, subject to R219,845 per insured person per annum)
- Oncology Extender: Covers approved costs above the annual scheme oncology limit when medical aid exhausts benefits
- Oncology “New-Tech” Benefit: Covers shortfall on new technology treatments (Keytruda®, Xalkori®, etc.), up to R17,325 per policy per annum
- Breast Reconstruction Surgery: Covers shortfall for oncology-related breast reconstruction, up to R36,750 per beneficiary per life of policy
- Additional Cover:
- Dental Benefit: Unlimited coverage for authorised in-hospital dental procedures (subject to aggregate annual limit)
Access to TRA Assist:
- Home Drive service (6 trips per annum per policy, 50km radius)
- 24-hour Panic Button with crisis management
- Roadguard security assistance
- Medical Health & Trauma Counselling Line (unlimited access to qualified nurses)
- COVID-19 Care Line
- Mobile app for claim submission
Waiting Periods & Limits
There is no general waiting period, HOWEVER, there are specific waiting periods of:
- 10 months for joint replacement, pregnancy, oncology etc.
- 6 months for pre-existing conditions
- 9 months for a first-time cancer diagnosis
The aggregate annual limit is R219 845 per insured person per annum across most benefits, with specific sub-limits applying to certain procedures. Contact your intermediary for detailed information about waiting periods and how they apply to your cover.
Who Qualifies for Absolute Cover Plus?
Absolute Cover Plus is available to members of registered medical aid schemes (not health insurance or primary care products). Cover extends to spouse and dependants on one registered medical aid policy together.
Members can be married or proven common-law partners (verified by an affidavit confirming 12 months of cohabitation) on different medical aids. There is no entry age limit. Contact your intermediary to learn about eligibility requirements and determine whether this gap cover product is right for you and your loved ones.
What’s Not Covered
Please note the following exclusions:
- Routine GP visits and out-of-hospital consultations
- Cosmetic surgery (unless medically necessary or oncology-related)
- Any procedures or treatments not partially covered by your medical aid scheme
Why Choose TRA’s Absolute Cover Plus?
- The gap cover option for medical aid members facing significant medical costs
- Premium-level protection against unexpected medical aid shortfalls and hospital expenses
- Extensive benefits for in-hospital procedures, oncology gap, casualty, and emergency medical care
- Specialised oncology treatment coverage, including the Oncology Gap Benefit, Oncology Co-Payment Benefit, Oncology Extender, and New-Tech benefits
- Covers co-payments, sub-limits, and global fee shortfalls
- Trusted gap cover provider with a renowned, efficient claims process in South Africa (payment runs 3 times per week)
- Extra protection for loved ones with accidental death, policy extender, and medical aid contribution waiver benefits
Monthly Premiums
Individual: R620 per policy per month
Family: R620 per policy per month (family)
Over 65’s: R770 per policy per month
(Premium based on age of oldest beneficiary)
How to Apply
You can apply online, and TRA’s team is ready to provide advice and support. Simply complete a claim form when needed, and we’ll ensure you’re protected from unexpected medical costs when your medical aid charges don’t cover the full cost of your treatment.
Review your medical aid plan and gap cover policy annually with your intermediary to ensure you’re getting the best cover for your needs.
Get Premium Gap Cover That Protects You AND Your Loved Ones
Your health is Total Risk Administrators’ (TRA) number one priority, and it shows in our short-term insurance policy options.
TRA’s Absolute Cover Plus is THE comprehensive choice for medical aid members who need extensive protection. Don’t let medical shortfalls catch you off guard – cover the gap between what your medical aid covers and what healthcare providers actually charge.
For further information, contact your intermediary or visit the TRA Gap Cover page to sign up.
