Unforeseen accidents and events are inevitable and can often be expensive, so the benefits of gap cover are undeniable. Gap cover provides benefits for policyholders and their spouses and those financially dependent on them.
You qualify for gap cover if you are already a member of a medical scheme. There are a number of benefits that are included in a comprehensive gap cover plan.
The benefits of having gap cover:
All gap cover options provide basic benefits
Gap cover goes beyond the limits of your medical aid. Most medical gap cover providers will provide in-hospital specialist gap cover and cover for medical aid imposed co-payments for procedures such as scopes and scans.
However, it is important to remember that gap cover cannot provide when your medical aid does not pay towards a procedure or has already covered the full amount for a procedure.
Provides lump sum pay-outs
Gap cover can also provide lump sum pay-outs for out of hospital costs when it is applicable. For example, gap cover provides Accidental Death Cover.
Avoid financial debt
The primary benefit of gap cover is that you may not have to risk going into financial debt when you or your family requires medical attention due to a life-changing event, such as an accident or illness.
Gives members of medical schemes the opportunity to see world-class specialists
Gap cover can give policyholders access to world-class treatments from specialists who charge above the medical aid rates.
For example, one of your family members may need robotic surgery but the best doctor for the procedure charges beyond your medical scheme limits. This family member may have had to find a different doctor that charges less for consultations and procedures if they did not have gap cover to cover the shortfall.
Save money by getting a more affordable medical scheme and compensating with gap cover
Members of medical schemes often opt to have a cheaper medical aid plan along with a flagship or mid-range gap cover policy. Flagship gap cover products can be relatively cheaper than having the most expensive medical scheme with no gap cover.
TRA Gap Cover benefits:
All benefits are subject to an annual limit of R198 660 per insured person.
Casualty Unit Benefit
All four TRA gap cover products have a casualty unit benefit which may cover shortfalls on costs related to an accident. It can also cover claims related to children under the age of 8 being admitted for any treatment during emergency hours. However, the casualty unit must be linked to a hospital.
Co-Payment benefit
TRA offers co-payments on approved in-hospital procedures, such as a gastronomy or a colonoscopy, as well as for other voluntary in-hospital procedures.
Cover for co-payments also includes certain scopes and scans such as MRI/ PET scans that happen out of hospital by approved in hospital specialists. These must first be paid by the In-Hospital or Major Medical Benefit by your medical aid.
Sub-Limit benefits
The sub-limit benefit refers to a medical shortfall that is not covered by your medical aid because you have reached the sub-limit. This includes hospital costs related to an internal prosthesis, MRI/ CT/ PET scans, colonoscopies and gastroscopies.
Dental Benefit
The dental benefit pays for the shortfalls for specific in-hospital and out of hospital procedures.
This benefit covers treatments for impacted wisdom teeth, extractions, apicectomies and loss of teeth due to trauma and oncology for adults over 18 years of age. The dental benefit also covers any procedure or treatment for dependants up to 18 years of age.
Global Fee Benefit
This benefit is used when a global fee has been negotiated between a medical aid and service providers and your doctor charges more than the global fee. This is for specific procedures such as robotic surgery.
Oncology Gap Benefits
TRA gap cover will cover the shortfalls on approved cancer related claims once the medical scheme pays for their portion of the costs related to the cancer treatment.
This ensures that you can prioritise your health and know that your treatment will not create a financial burden for you or your family.
Maternity Private Ward Benefit
Gap cover will cover the difference between the General Ward rate and the Private Ward Rate for hospitalisation for childbirth.
Travel Benefit
TRA offers comprehensive travel insurance to all policyholders travelling outside of South Africa. This travel insurance is underwritten by Guardrisk Insurance Company Limited, a licensed non- life insurer, and administered by Hepstar Financial Serviced (Pty) Ltd, both being registered Financial Service Providers.
TRA Assist Benefits
TRA gap cover provides access to a mobile app for all policyholders. These benefits include a panic button which gives you 24-hour access to a crisis manager who will guide you through your emergency.
The TRA assist app also offers a Home Drive benefit which is a driver service that offers “own vehicle” or “Uber” services. Policyholders can also submit claims via the mobile app.
There is also a Medical Health and Trauma Counselling Line which gives you 24- hour access to qualified nurses for telephonic emergency medical advice to help policyholders feel that they have constant assistance.
