Applies to authorised in-hospital and in-lieu of hospital procedures, where the medical aid pays a portion of the fees from its in-hospital or major medical benefit. (Includes MRI/ CT/PET scans consumables.)

R500 per policy per annum.

Cover for the shortfall on a specialist account related to the consultation in the rooms before a member is going for an in-hospital procedure.

Limited to the following number of consults p.p.p.a (up to a max of R500 per consult).

1 consult per policy per annum.

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 465 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.

Casualty follow-up consultations

(The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.) 

1 follow-up consultation per policy per annum at an ER unit (accident-related only).

• 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 350 in the event of death of the insured and / or spouse, and R4 200 in the event of the death of the dependant, caused by violent, accidental, external, or visible means.

• Benefits: Home Drive, Uber, Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (including a COVID-19 care line) and Claims Submissions.
• Click here for more information.

• 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 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).

• 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.

• Benefits include but are not limited to:
  • Emergency Medical and Related expenses: R1 000 000
  • Medical Evacuation, Repatriation or Transportation to a Medical Centre: Actual expense covered when arranged by Hepstar Financial Services.
  • Personal Accident Cover: Death: R25 000 / Permanent Disability: up to R25 000
  • Theft or Accidental Damage during trip: R5 000 / Single item limit: R1 500
  • Theft, Damage or loss by Airline: R5 000 / Single item limit: R1 500
  • Baggage Delay (more that 4 hours): R500
  • Baggage Delay (more that 24 hours): R1 000