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 authorised cancer treatment.
This gap cover product includes the most comprehensive set of benefits TRA offers, with most categories effectively uncapped within the aggregate annual limit of R219 845 per insured person per annum. It is the only TRA plan to include out-of-network emergency medical services shortfall cover and the higher private ward rate.
Please note that gap cover is not a substitute for medical aid. It is a supplementary health insurance policy for medical aid members.
Key Benefits & Features (Updated for 2026)
Core gap cover
- Above tariff cover: Covers up to 700% of medical scheme tariff for in-hospital shortfalls (subject to the aggregate annual limit of R219 845 per insured person per annum). For more on what tariff percentages mean, see gap cover tariff percentages explained
- Specialist consultation shortfalls: 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 medical services, subject to the aggregate annual limit. (Available on Absolute Cover Plus only)
Hospital procedure cover
- Co-payment cover (in-network): Unlimited co-payments for diagnostic and endoscopic procedures when using designated networks (subject to the aggregate annual limit)
- Co-payment cover (out-of-network): Up to 2 co-payments per policy per annum, combined limit of R17 640
- Co-payment cover for out-of-hospital MRI/CT/PET scans: 2 scans per policy per annum, unlimited subject to the aggregate annual limit
- Sub-limit benefit for internal prostheses: Unlimited subject to the aggregate annual limit, up to R71 663 per event
- Sub-limit benefit for MRI/CT/PET scans: 2 scans per policy per annum, up to R6 615 per scan
- Sub-limit benefit for colonoscopies and gastroscopies: Up to R24 225 per insured person per annum, up to R6 300 per event
- Global fee benefit: Covers shortfalls when providers charge above negotiated global fees on robotic and similar procedures, up to R26 460 per policy per annum
- Tariff shortfalls for theatre and ward fees, consumables, laparoscopic/endoscopic equipment: Up to R5 250 per policy per annum
Casualty Cover
- Casualty cover: Visits for accidents to casualty units – up to R24 255 per policy per annum (accidents only, with extended emergency and after-hours cover, for children under 8 only)
- Casualty follow-up consultations: 1 follow-up consultation per policy per annum at an ER unit (accident-related only)
Maternity & family
- Premature birth benefit: A fixed payout of R20 000 per policy per annum when a baby is born before 34 completed weeks of gestation (excludes elective deliveries)
- Maternity follow-up consultations: Up to R1 313 per consultation per policy per annum for OBGYN or paediatrician shortfalls within 6 weeks after childbirth
- Private ward benefit (childbirth): Up to R2 205 per day for 3 consecutive days
- Private ward benefit (non-childbirth): Up to R2 205 per day for 3 consecutive days
Oncology benefits
- Oncology gap benefit: Unlimited cover for shortfalls on medical aid approved oncology treatment plans, subject to the aggregate annual limit
- Oncology co-payment benefit (in-network): Unlimited subject to the aggregate annual limit
- Oncology co-payment benefit (out-of-network): Up to 2 co-payments per policy per annum, combined limit of R17 640
- Oncology extender benefit: Unlimited cover for approved costs above the medical aid’s annual oncology limit, subject to the aggregate annual limit
- Oncology “new-tech” benefit: Covers shortfalls on new technology oncology treatments (Keytruda®, Xalkori®, Tagrisso®, Yervoy®, Zelboraf®, Imbruvica®), up to R18 191 per policy per annum
- Breast reconstruction surgery: Up to R38 588 per beneficiary per life of policy for oncology-related breast reconstruction, including the unaffected breast
Recovery and additional cover
- Step-down facility benefit: A once-off lump sum of R12 000 per insured person per annum from day 11 onwards for extended stays in a registered step-down or sub-acute care facility following hospitalisation
- Targeted pain relief during surgery or severe trauma: Unlimited, subject to the aggregate annual limit
- Hospitalised psychiatric care: Up to 21 days
- Dental benefit: Cover for authorised in-hospital dental procedures (unlimited, subject to the aggregate annual limit, and subject to strict terms and conditions/limited cover as stipulated in the policy document)
Family protection
- Accidental death cover: R33 000 for main member/spouse, R22 000 for dependants
- Policy extender: Full gap cover premium covered for 12 months after the accidental death of the main policyholder
- Medical aid contribution waiver: Up to R7 275 per month for 6 months, in the case of the accidental death of the main policyholder
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 and Trauma Counselling Line (unlimited access to qualified nurses)
- Mobile app for claim submission
Travel insurance: Comprehensive travel insurance underwritten by Guardrisk Insurance Company Limited is included at no additional cost for policyholders under 71
Waiting Periods & Limits
There is no general three-month waiting period on a TRA Absolute Cover Plus policy. The following specific waiting periods apply, running from the join date:
- 10 months for the specified condition list (joint replacement, pregnancy, oncology and others; see our gap cover and pre-existing conditions article for the full list)
- 9 months for a first-time cancer diagnosis made before the policy starts
- 6 months for any other pre-existing condition
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 more detail on how waiting periods apply to your specific 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 a spouse and dependants on one registered medical aid policy.
Members can also 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 discuss eligibility and to confirm whether Absolute Cover Plus is the right product for you and your loved ones.
What Is Not Covered
Please note the following exclusions:
- Routine GP visits and out-of-hospital consultations
- Cosmetic surgery (unless medically necessary or oncology-related)
- Out-of-hospital dental treatment (unless from accidental trauma or oncology, or for dependants under 18)
- Any procedure or treatment not partially covered by your medical aid scheme
Always check the official 2026 TRA brochure for the complete list of exclusions.
Why Choose TRA’s Absolute Cover Plus?
- The most comprehensive 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, casualty and emergency medical care
- Specialised oncology cover, including the oncology gap, co-payment, extender and new-tech benefits
- Covers in-network and out-of-network co-payments, sub-limits, and global fee shortfalls
- Only TRA plan to include out-of-network emergency medical services (ambulance) shortfall cover
- Trusted gap cover provider with an efficient claims process. Payment runs three times a week
- Extra protection for loved ones, with accidental death, policy extender and medical aid contribution waiver benefits
Monthly Premiums for 2026
- Individual: R681 per policy per month
- Family: R681 per policy per month (premium based on the age of the oldest beneficiary)
- Over-65s: R846 per policy per month
Frequently Asked Questions About Absolute Cover Plus
How much does Absolute Cover Plus cost in 2026?
R681 per month for policies where the oldest beneficiary is under 65, and R846 per month for over-65 policyholders. The premium is the same for an individual or a family policy.
What is the difference between Super Cover Plus and Absolute Cover Plus?
Absolute Cover Plus matches Super Cover Plus on the 700% tariff ceiling but makes most other benefits effectively unlimited within the aggregate annual limit. It is also the only TRA plan to include out-of-network emergency medical services (ambulance) shortfall cover, and the only plan with the higher R2 205 per day private ward benefit. Co-payment, MRI/CT/PET, oncology extender, internal prostheses and oncology in-network co-payment cover all step up significantly from Super Cover Plus.
Does Absolute Cover Plus cover robotic surgery shortfalls?
Yes. The global fee benefit covers shortfalls when providers charge above the negotiated global fee for robotic procedures , up to R26 460 per policy per annum.
Does Absolute Cover Plus cover ambulance shortfalls?
Yes. Absolute Cover Plus is the only TRA plan that includes shortfall cover for out-of-network (non-DSP) emergency medical services, which is unlimited, subject to the aggregate annual limit.
Can I claim immediately on a new Absolute Cover Plus policy?
There is no general three-month waiting period. You can claim from the start date on anything that is not on the ten-month condition-specific list and not related to a pre-existing condition etc. Read our pre-existing conditions article for the full breakdown.
Does Absolute Cover Plus cover cancer treatment?
Cancer claims are subject to the nine-month waiting period if the cancer was diagnosed before the policy started. (Also, if a Policyholder has previously been diagnosed with cancer and is currently in remission, the Policyholder needs to advise the insurer by way of medical evidence that the remission period has been for two (2) or more consecutive years.)
Once that waiting period is past, Absolute Cover Plus provides the broadest oncology cover TRA offers: oncology gap benefit, in-network and out-of-network oncology co-payment cover, oncology extender benefit (uncapped, subject to the aggregate annual limit), oncology “new-tech” benefit up to R18 191 per year, and breast reconstruction surgery cover up to R38 588 per beneficiary per life of policy.
How to Apply
You can apply online, and TRA’s team is ready to provide advice and support. Simply complete and submit a claim form when needed, and we will make sure you are protected from unexpected medical costs when your medical aid charges do not cover the full cost of your treatment.
Review your medical aid plan and gap cover policy annually with your intermediary/broker, to ensure you are still on the right 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 the most extensive protection available. Do not 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, visit the TRA Gap Cover page to sign up.
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.
