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 R150 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

  • Unfortunately, cancer statistics show that cancer diagnoses are increasing dramatically every year.
  • With an early start to treatment, one can recover. But, the costs for cancer treatments are rising too. Specialists are also charging more than medical aids are obliged to cover, creating a substantial gap.
  • You will receive up to an aggregate of R150 000* per insured person per annum to assist where your service provider has charged more than the rate at which the medical aid reimburses, provided it is treatment which has been approved by your medical aid, and it is within your annual scheme limit.

Oncology Extender

  • As previously mentioned, cancer treatment costs are rising and some medical aids impose annual oncology limits to curb these costs.
  • In addition, they may cover further costs above the limit but with the member having to contribute a share or percentage.
  • This benefit will provide cover up to R120 000 (subject to the annual limit*), for oncology costs once the member has reached their oncology limit imposed by their medical aids.

Co-Payment

  • 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-payments or deductible events per policy per annum, to a combined maximum of R12 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: This benefit provides an amount of up to R30 000  per event and up to a maximum of R90 000 per policy per annum, subject to the annual limit*.
  • MRI / CT / PET scans sub-limit: This benefit provides for 2 MRI or CT 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 R5 000 in the event of death of the insured and / or spouse, and R2 500 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.

TRA ASSIST powered by ER24 ASSIST

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

*Subject to the aggregate gap cover annual limit of R150 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 – 2018

Pacemaker  R45 100.00
 Hip Replacement  R41 800.00
 Stent  R25 300.00
 Knee Replacement  R39 050.00

*Cover provided by Absolute Cover Plus only.

ONCOLOGY
EXTENDER
2018

 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 R150 000 per insured person per annum.
(This may change due to regulatory amendment).