Absolute Cover Plus is our flagship product which provides Gap Cover, Casualty cover, Oncology Gap and Co-Payment cover as standard benefits, and also provides Sub-Limit cover, as well as an Oncology Extender benefit.

Benefits: Absolute Cover Plus*

The Absolute Cover Plus option covers up to 700% above medical aid scheme tariff. This means that if your service provider charges anything up to 7 times what your medical aid will cover, TRA will provide for this gap, subject to the annual limit.**

*Annual Limit: The Basic Gap, Casualty, Oncology Gap, Co-Payment cover, Sub-Limit cover and Oncology Extender benefit are subject to the aggregate gap cover annual limit of R158 000 per insured person per annum. (This limit may change due to regulatory amendment).

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Casualty

  • Sometimes emergencies occur and you need to rush to casualty.
  • Your medical aid does not always cover the total costs in full. Whether payment comes from your medical scheme savings account or day-to-day benefit, the gap will be covered.
  • Sometimes, your medical aid will not account for anything regarding this casualty visit, leaving you to cover the bill in full.
  • This benefit will cover you for up to R15 000 per policy per annum (subject to the annual limit*), EVEN IF YOUR MEDICAL AID COVERS NOTHING.

Oncology Gap

  • Oncology Gap Benefit: Up to an aggregate of R158 000 per insured person per annum. The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology treatment plans (NB: Subject to the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit).

Oncology Co-Payment Benefit: Unlimited per policy per annum but subject to R158 000 per insured person per annum.

  • The co-payment or deductible that your medical aid charges you for certain in-hospital procedures. This co-payment is NOT related to the scheme tariff and service provider charge shortfall or designated service provider none arrangements, OR
  • For claims where the medical aid will only pay a percentage for the approved treatment and the policyholder needs to pay the remaining percentage of the account.
  • All costs to be within the annual scheme oncology limit.

Oncology Extender

  • Includes ANY approved costs above annual scheme oncology limit but subject to scheme covering up to this limit. Unlimited per policy per annum but subject to R158 000 per insured person per annum.

Co-Payment

  • Unlimited per policy per annum but subject to R158 000 per insured person per annum.
  • These days most medical aid schemes insist that members pay an upfront amount for certain diagnostic and endoscopic procedures like gastroscopies and colonoscopies.
  • This amount is known as a co-payment or deductible.
  • The amount of times and total you can claim from this Co- Payment benefit is Unlimited (subject to the annual limit*), provided you make use of your medical aid’s designated service provider network.
  • Where a policyholder voluntarily chooses to make use of a service provider that is NOT part of their medical aid’s designated service provider network, this benefit will be limited to 2 co-payment or deductible events per policy per annum, to a combined maximum of R14 000, subject to the annual limit*.

Sub-Limit

  • These days most medical aid schemes impose a sub-limit on in-hospital prostheses costs and some even limit the monetary amount that is available for MRI and CT and PET scans. In both cases, members may be out of pocket and will have to cover these costs themselves.
  • Prosthesis sub-limit: Unlimited but subject to R158 000 per insured person per annum. Up to R30 000 per event.
  • MRI / CT / PET scans sub-limit: This benefit provides for 2 MRI or CT or PET scans per policy per annum and up to R4 000 per scan, subject to the annual limit*.
  • No other sub-limits are included in this benefit.

Accidental Death

  • Accidents happen! Unfortunately, some severe accidents may even result in death. The situation is made worse if that person was the main breadwinner.
  • Costs can run into the thousands and often funds are tied up to an estate.
  • This benefit will provide an amount of R8 000 in the event of death of the insured and/or spouse, and R4 000 in the event of the death of the dependant, caused by violent, accidental, external, or visible means.

Policy Extender

  • We often hear of cases where one of our policyholders passes away, leaving their loved ones to pick up the pieces. They are left with the challenge to make sure that the gap cover they were used to is funded for a period of time.
  • This benefit will provide for your gap cover contributions for a period of 6 months after the death of the original policyholder.

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  • Benefits: Home Drive, Panic Button, Nurse Line.

*Subject to the aggregate gap cover annual limit of R158 000 per insured person per annum.

TERMS AND CONDITIONS:
Annual limits apply in aggregate, per annum, per beneficiary, per incident unless otherwise indicated. A full list of terms and conditions can be viewed here.

*PROSTHESES SUB-LIMIT EXAMPLES THAT MAY BE IMPOSED BY YOUR MEDICAL AID – 2019

Pacemaker  R49 610.00
 Hip Replacement  R45 980.00
 Stent  R27 830.00
 Knee Replacement  R42 955.00

*Cover provided by Absolute Cover Plus only.

ONCOLOGY
EXTENDER
2019

 Oncology Treatment  Medical aid Limit  Oncology Extender  Your Share
 R264 000.00  R 220 000.00  R 44000.00  NIL

*Cover provided by all 4 Gap products.

*Subject to Product Option benefits and Imposed Waiting Periods.
*Subject to the aggregate gap cover annual limit of R158 000 per insured person per annum.
(This may change due to regulatory amendment).