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The gap is covered in instances where there is a shortfall between what service providers charge and what your medical aid scheme will cover for in-hospital expenses. No more stress needed here. We have four product options which have been tailor-made to suit your needs.

Like most people, you have a medical aid to give you peace of mind that if you need medical care for any reason – be it through accident or illness – your bills will be taken care of. After all, who needs to add financial worry to the stress of being hospitalised?

And… like most people, you probably assume that if you have a medical aid, then you’re 100% covered. Unfortunately, this is not always true – which is why you need gap cover to ensure that you don’t receive a huge hospital bill if there’s a shortfall between what the doctors charge and what your medical aid will pay.

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NB: Please note that if you are still on a ‘Non-Plus’ product option which is closed to new business i.e. Super Cover or Absolute Cover (different to Super Cover Plus and Absolute Cover Plus as per the table below), you will not be covered for PMB’s i.e Prescribed Minimum Benefits as explained in the table below.

CORPORATE / GROUP BUSINESS

We welcome the opportunity to quote on any corporate or group business and we are able to offer tailored and discounted products based on size and demographics. Intermediaries/brokers should contact us directly to discuss these opportunities.

*SUBJECT TO THE AGGREGATE GAP COVER ANNUAL LIMIT OF R150 000 PER INSURED PERSON PER ANNUM.

Refer to policy document for full details of limitations and exclusions.

Terms and conditions apply. This matrix does not constitute advice. Consult your intermediary for guidance in choosing the product that is right for your needs. Prescribed Minimum Benefits (PMB’s) are covered.

All of the Gap Cover policies:

  • Provide benefits for members and their dependants (spouse and/or child/children) who are covered on one policy of a registered medical aid scheme. Members and their dependants can only be on two different medical aids and one Gap Cover Policy if they are legally married, or common law partners verified by submission of an affidavit confirming 12 months of cohabitation.
  • Have no entry age limit.
  • Allow immediate benefits for all policyholders except for a limited list of specific conditions and/or procedures. (There is no general 3 month waiting period!)
  • May provide immediate cover for many procedures including: All emergency procedures, sterilisations, vasectomies, tonsillectomies, appendectomies, gall bladder removal or procedures and conditions not specifically excluded where a medical aid has failed to meet its full obligation.
  • Cover Prescribed Minimum Benefits (PMBs) where a medical aid has failed to meet its obligations in this regard (for non-emergencies only).
  • Are not medical aid schemes. The cover is not  the same as that of a medical aid scheme. The cover is not a subsitute for a medical scheme membership.
  • 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).
  • All of our 2018 product options offer the following TRA ASSIST (powered by ER24 ASSIST) benefits:
    – Home Drive
    – Panic Button
    – Nurse Line
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TERMS AND CONDITIONS
A full list of terms and conditions can be viewed here.

Contact us for more information about Gap Cover today.