Do you know what the annual aggregate limit for your gap cover provider is and how this can affect you and your family?

Terms used in insurance can often be complicated and overwhelming. However, it is important for medical aid and gap cover members to understand what these terms mean and how it affects their medical scheme and short-term insurance products.

What is the annual aggregate limit for gap cover?

The annual aggregate limit refers to the maximum amount of money that your gap cover provider will pay for all claims that you submit over the course of one year.

So this could affect you and your family if your medical expenses shortfalls exceed this amount, as you will be expected to pay for any shortfalls for the remainder of the year.

How do insurers decide their annual aggregate limit?

All TRA Gap Cover policies are governed by the demarcation regulations which allows this figure to be increased every April by an amount linked to South Africa’s inflation rate.

However, this often meant that this limit was inconsistent and was open to interpretation from different insurance product suppliers.

Recently, the demarcation regulations have issued a definitive table of figures for determining the annual aggregate limit. This will ensure that gap cover providers offer a consistent and stable limit.

What is TRA’s limit?

As a result of the issued table of figures, the current annual aggregate limit for TRA gap cover is R185 837,00 per insured person.

This limit came into effect on 1 April 2022 and will change again on 1 April 2023. The annual aggregate limit has changed from R177 800 per insured person which was effective from 1 January 2022 to 31 March 2022.

The AAL table is updated as the regulations come out. This AAL table was and will be linked in the year-end communication letters to policyholders. It is also on our application forms and brochures as new members join, so that they can keep up to date.

Click on this link to see the latest table: https://www.totalrisksa.co.za/downloads/TRA-AAL-Table.pdf

Our gap cover brochure also outlines the details: https://totalrisksa.co.za/2022-brochure-download-thank-you/ 

The new amount will also be updated on our website each year: https://totalrisksa.co.za/gap-cover/

Contact our team for further queries.

Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgment available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.