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Gap Cover:

Basic Cover 300

Our entry level product

Basic Cover 300 is our entry level product which is sufficient in providing for Gap cover, Casualty cover and a separate Oncology Gap cover benefit.

Premium Per Policy Per Month

INDIVIDUAL

R99 p/m

FAMILIES

R180 p/m

OVER 65’s

R360 p/m

The Basic Cover 300 option covers up to 300% above medical aid scheme tariff.
This means that if your service provider charges anything up to 3 times what your medical aid will cover, TRA will provide for this GAP, subject to the annual limit.

BASIC COVER 300

Benefits

BASIC COVER 300

Benefits

CASUALTY
  • Sometimes accidents 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, provided it is for an ACCIDENT, and the treatment provided is at a casualty unit linked to a hospital.
  • Sometimes the 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 R3 300 per policy per annum (subject to the annual limit*)  EVEN IF YOUR MEDICAL AID COVERS NOTHING.
  • Children under the age of 8 ONLY – May be admitted for any treatment at a casualty unit linked to a hospital between the hours of 7 pm to 7 am from Monday to Friday, from 7 pm on a Friday until 7 am on a Monday, and all day on a public holiday
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 R7 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.
TRA ASSIST
  • Benefits: Home Drive, Uber, Panic Button, Medical Health Line, Trauma Counselling Line (including a COVID-19 care line) and Claims Submissions.
  • Click here for more information.
DENTAL BENEFIT
  • Dental Benefit: Up to an aggregate of R210 580 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 authorised dental procedures performed in hospital or in doctor’s rooms and paid from the in-hospital or major medical benefit only.
  • The cover is limited to a percentage of the original scheme tariff, as follows:
    • Adults and dependants over 18 years of age: Treatment of impacted wisdom teeth, extractions, apicoectomies or loss of teeth due to oncology or trauma ONLY.
    • Dependants up to 18 years of age: Any procedure or treatment.
ONCOLOGY
  • Oncology Gap Benefit: Up to an aggregate of R210 580 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 (In Network): No Benefit
  • Oncology Co-Payment Benefit (Out Of Network): No Benefit
  • Oncology Extender Benefit: No Benefit
  • Oncology ‘New-Tech’ Benefit: No Benefit
  • Oncology Gap Benefit – Breast Reconstruction Surgery: No Benefit
  • Maternity Private Ward Benefit: No Benefit
  • Global Fee Benefit: No Benefit
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 premiums for a period of 12 months after the accidental death of the original policyholder.
TRAVEL BENEFIT
  • Benefits include but are not limited to:
    • Emergency Medical and Related expenses: R600 000. Excess R500.
    • COVID-19 Extension: Emergency inpatient or outpatient treatment due to COVID-19 R600 000.
    • Medical evacuation, repatriation or transportation to a medical centre – FULL COST covered when arranged by Hepstar.
    • Hospital Cash benefit R500 per day (max R3 000).
    • Inconvenience Cover: Baggage Cover: R5 000 for theft, damage or loss by travel supplier.

GET BASIC GAP COVER NOW!*

*Annual Limit: The Basic Gap, Casualty and Oncology Gap benefits are subject to the aggregate gap cover annual limit of R210 580 per insured person per annum. (This limit may change due to regulatory amendment).

A full list of 2024 terms and conditions can be viewed here .

A full list of 2024 terms and conditions can be

Basic Cover 300 - gap cover example

HIATUS HERNIA REPAIR

Michelle saved R 9086.36.
By choosing Basic Cover 300, you can too.

Your medical aid, just like Michelle’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.

Eliminate the financial worry from the stress of a hospital operation or stay.

Attending Doctor


Surgeon

Specialist Anaesthesiologist

Private Rate


R 11 593.84

R 8 871.10


R 20 464.94

Medical Aid Tariff


R 7 823.60

R 3 554.98


R 11 378.58

Gap Cover


R 3 770.24

R 5 316.12


R 9 086.36

Your Share


R 0

R 0


R 0

TERMS AND CONDITIONS APPLY

Young woman smiling

GAP COVER EXAMPLE

HIATUS HERNIA REPAIR

Michelle saved R 9086.36.
By choosing Basic Cover 300, you can too.

Young woman smiling

Your medical aid, just like Michelle’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.

Eliminate the financial worry from the stress of a hospital operation or stay.

Basic Cover 300 - Tariffs Payed

TERMS AND CONDITIONS APPLY

GAP COVER EXAMPLE

HIATUS HERNIA REPAIR

Young woman smiling

Michelle saved R 9086.36.
By choosing Basic Cover 300, you can too.

Your medical aid, just like Michelle’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.

Eliminate the financial worry from the stress of a hospital operation or stay.

Attending Doctor


Surgeon

Specialist Anaesthesiologist

Private Rate


R 11 593.84

R 8 871.10


R 20 464.94

Medical Aid Tariff


R 7 823.60

R 3 554.98


R 11 378.58

Gap Cover


R 3 770.24

R 5 316.12


R 9 086.36

Your Share


R 0

R 0


R 0

TERMS AND CONDITIONS APPLY

GAP COVER EXAMPLE

HIATUS HERNIA REPAIR

Young woman smiling

Michelle saved R 9086.36.
By choosing Basic Cover 300, you can too.

Your medical aid, just like Michelle’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.

Eliminate the financial worry from the stress of a hospital operation or stay.

Attending Doctor


Surgeon

Specialist Anaesthesiologist

Private Rate


R 11 593.84

R 8 871.10


R 20 464.94

Medical Aid Tariff


R 7 823.60

R 3 554.98


R 11 378.58

Gap Cover


R 3 770.24

R 5 316.12


R 9 086.36

Your Share


R 0

R 0


R 0

TERMS AND CONDITIONS APPLY

FREQUENTLY ASKED QUESTIONS

What is Gap Cover?​

Gap Cover is an insurance policy that covers the difference between what your medical aid pays and what service providers charge for in-hospital expenses.

 

How do I claim from Gap Cover?

Claims – Manual and Automatic Processes

The policyholder is responsible for ensuring that claims are submitted and received by TRA within six (6) months from the treatment date. The policyholder should also ensure that TRA has the correct banking details into which we must pay the claim.

 

Claims – Manual Process

Policyholders need to submit the following:

  • The claim from the service provider.
  • The first two pages of the hospital account that show the hospital event’s admission and discharge dates.
  • The medical aid statement showing the payment of the service provider claim and the reason for the short payment.
  • You can email these claims documents to claims@totalrisksa.co.za or submit them via our website, www.totalrisksa.co.za or our mobile app, TRA Assist.
  • Alternatively, you can contact TRA directly at +27 (11) 372 1540. One of our highly qualified and friendly claims specialists will gladly assist.

 

Claims – Automatic Process

TRA receives claims submitted by selected medical aid schemes on behalf of the policyholder. Should your medical aid company have such an agreement with TRA, it is optional for the policyholder to submit their claim to TRA.

 

TRA will receive an electronic version of the claim and will process the said claim within seven working days of receipt thereof.

 

Co-payment and sub-limit claims must always be submitted manually by the policyholder (in addition to all the required claims documentation, please also provide proof of any direct payment/s made to these service providers).

 

Should a claim be rejected because additional information (e.g. pre-authorisation letter, medical aid statement, doctor’s account or the first two pages of the hospital account) is not received, all the information must be submitted to TRA within 31 days from the date of the request or the claim will be rejected as late/stale in terms of this policy and will not be paid.

Why do I need Gap Cover?

Most people purchase medical aid and assume they will take care of all their medical bills. Unfortunately, this is not always true. Medical shortfalls can occur if you need medical care for any reason – accident or illness. You don’t want to add financial worry to the stress of being hospitalised, which is why you need Gap Cover.

 

Gap Cover ensures you don’t receive a massive bill if there’s a shortfall between what the doctors charge and what your medical aid will pay for in-hospital procedures.

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