Gap Cover
Policies
Reliable
Gap Cover
Gap Cover is an insurance policy that covers the gap between what your medical aid pays and what service providers charge for in-hospital expenses. Healthcare in South Africa is expensive, and most medical aids only cover part of the healthcare providers’ actual rate.
Gap Cover offers you extra protection, covering the shortfall of your medical aid.
However, Gap Cover is not a medical aid and does not replace your medical aid.
Waiting periods may apply.
Cover up to 700%
Fast Claim
Payouts
Easy Claims
Process
Excellent
Service
Out-of-hospital
Benefits
Affordable Prices
From R99 p/m
Automatic Claim
Submission
STANDARD BENEFITS
Gap Cover
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment
Shortfalls on Specialist Consultations
Casualty Cover and Casualty follow-up consultations
Oncology Gap
Accidental Death Cover
Policy Extender
TRA Assist powered by MobiMed
Travel benefit
From R99/m
STANDARD BENEFITS
Gap Cover
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment
Shortfalls on Specialist Consultations
Casualty Cover and Casualty follow-up consultations
Oncology Gap
Accidental Death Cover
Policy Extender
TRA Assist powered by MobiMed
Travel benefit
From R99/m
Basic Cover 300 | Vital Cover Plus | Super Cover Plus | Absolute Cover Plus | |
---|---|---|---|---|
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a) |
||||
Gap Cover Percentage* | 300% | 700% | 700% | 700% |
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* 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 |
R1 000* per |
Up to R3 000* per |
Up to R5 000* per |
PMB's* Covered, subject to medical aid review |
||||
Shortfalls on Specialist Consultations* 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 |
2 consult per |
3 consult per |
4 consult per |
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services. |
Unlimited but subject to the aggregate annual limit per insured person per annum p/a* |
|||
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks) |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks) |
1 co-payment |
2 Co-payments / |
||
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS |
1 MRI / CT / PET |
2 scans per |
||
SUB-LIMITS*: INTERNAL PROSTHESES |
Up to R5 775* per |
Up to R11 550* per |
Unlimited |
|
SUB-LIMITS*: MRI / CT / PET SCAN |
1 |
2 |
||
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES |
Up to R13 650* per
Up to R3 780* per |
Up to R23 100* per
Up to R6 300* per |
||
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a |
||||
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital)
|
Up to R3 465* per |
Up to R9 240* per |
Up to R13 650* per |
Up to R23 100* per |
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 |
1 follow-up consultation |
1 follow-up consultation |
1 follow-up consultation |
GLOBAL FEE BENEFIT* |
Up to R12 600* per |
Up to R25 200* per |
||
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit) |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)* |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK) |
1 co-payment per |
2 Co-payments per |
||
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit) |
Up to R36 750* per |
Unlimited* |
||
ONCOLOGY “NEW-TECH” BENEFIT* |
Up to R8 610* per |
Up to R17 325* per |
||
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY* |
Up to R18 900* per |
Up to R36 750* per |
||
MEDICAL AID CONTRIBUTION WAIVER
Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed. |
6 months. |
6 months. |
6 months. |
|
Maternity Follow-Up Consultations
Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth |
Up to R7 00* per |
Up to R1 250* per |
||
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred. |
||||
For Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2 100 per day, for a total of 3 consecutive days |
||
For Non-Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2100 per day, for a total of 3 consecutive days |
||
ACCIDENTAL DEATH Insured / Spouse |
R7 350 |
R10 500 |
R21 000 |
R31 500 |
ACCIDENTAL DEATH Dependant |
R4 200 |
R5 775 |
R8 400 |
R21 000 |
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder) |
||||
TRAVEL BENEFIT |
||||
Emergency Medical and Related expenses up to R1 000 000. |
||||
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500. |
||||
Baggage Delay (more than 4 hours) R500 | ||||
Baggage Delay (more than 24 hours) R1 000 |
||||
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions. |
||||
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 380 | R 620 | |
Premium per Individual per policy per month |
R 99 | |||
Premium per Family per policy per month |
R 180 | |||
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 540 | R 570 | R 770 |
ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover (including for Oncology)
Sub-Limit Cover (internal prostheses)
Medical Aid Contribution Waiver
ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover (including for Oncology)
Sub-Limit Cover (internal prostheses)
Medical Aid Contribution Waiver
From R360/m
Basic Cover 300 | Vital Cover Plus | Super Cover Plus | Absolute Cover Plus | |
---|---|---|---|---|
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a) |
||||
Gap Cover Percentage* | 300% | 700% | 700% | 700% |
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* 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 |
R1 000* per |
Up to R3 000* per |
Up to R5 000* per |
PMB's* Covered, subject to medical aid review |
||||
Shortfalls on Specialist Consultations* 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 |
2 consult per |
3 consult per |
4 consult per |
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services. |
Unlimited but subject to the aggregate annual limit per insured person per annum p/a* |
|||
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks) |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks) |
1 co-payment |
2 Co-payments / |
||
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS |
1 MRI / CT / PET |
2 scans per |
||
SUB-LIMITS*: INTERNAL PROSTHESES |
Up to R5 775* per |
Up to R11 550* per |
Unlimited |
|
SUB-LIMITS*: MRI / CT / PET SCAN |
1 |
2 |
||
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES |
Up to R13 650* per
Up to R3 780* per |
Up to R23 100* per
Up to R6 300* per |
||
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a |
||||
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital)
|
Up to R3 465* per |
Up to R9 240* per |
Up to R13 650* per |
Up to R23 100* per |
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 |
1 follow-up consultation |
1 follow-up consultation |
1 follow-up consultation |
GLOBAL FEE BENEFIT* |
Up to R12 600* per |
Up to R25 200* per |
||
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit) |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)* |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK) |
1 co-payment per |
2 Co-payments per |
||
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit) |
Up to R36 750* per |
Unlimited* |
||
ONCOLOGY “NEW-TECH” BENEFIT* |
Up to R8 610* per |
Up to R17 325* per |
||
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY* |
Up to R18 900* per |
Up to R36 750* per |
||
MEDICAL AID CONTRIBUTION WAIVER
Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed. |
6 months. |
6 months. |
6 months. |
|
Maternity Follow-Up Consultations
Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth |
Up to R7 00* per |
Up to R1 250* per |
||
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred. |
||||
For Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2 100 per day, for a total of 3 consecutive days |
||
For Non-Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2100 per day, for a total of 3 consecutive days |
||
ACCIDENTAL DEATH Insured / Spouse |
R7 350 |
R10 500 |
R21 000 |
R31 500 |
ACCIDENTAL DEATH Dependant |
R4 200 |
R5 775 |
R8 400 |
R21 000 |
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder) |
||||
TRAVEL BENEFIT |
||||
Emergency Medical and Related expenses up to R1 000 000. |
||||
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500. |
||||
Baggage Delay (more than 4 hours) R500 | ||||
Baggage Delay (more than 24 hours) R1 000 |
||||
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions. |
||||
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 380 | R 620 | |
Premium per Individual per policy per month |
R 99 | |||
Premium per Family per policy per month |
R 180 | |||
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 540 | R 570 | R 770 |
ALL VITAL COVER BENEFITS PLUS
Out of Network Co-Payment Cover (including for Oncology)
Co-Payment: Out of Hospital MRI/CT/PET Scans
Sub-Limit Cover for MRI/CT/PET scans and Colonoscopies and Gastroscopies
Global Fee Benefit
Oncology Extender Benefit
Oncology “New-Tech” Benefit
Oncology Gap Benefit for Breast Reconstruction Surgery
Maternity Follow-Up Consultations
Private Ward Benefit
From R380/m
ALL VITAL COVER BENEFITS PLUS
Out of Network Co-Payment Cover (including for Oncology)
Co-Payment: Out of Hospital MRI/CT/PET Scans
Sub-Limit Cover for MRI/CT/PET scans and Colonoscopies and Gastroscopies
Global Fee Benefit
Oncology Extender Benefit
Oncology “New-Tech” Benefit
Oncology Gap Benefit for Breast Reconstruction Surgery
Maternity Follow-Up Consultations
Private Ward Benefit
From R380/m
Basic Cover 300 | Vital Cover Plus | Super Cover Plus | Absolute Cover Plus | |
---|---|---|---|---|
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a) |
||||
Gap Cover Percentage* | 300% | 700% | 700% | 700% |
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* 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 |
R1 000* per |
Up to R3 000* per |
Up to R5 000* per |
PMB's* Covered, subject to medical aid review |
||||
Shortfalls on Specialist Consultations* 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 |
2 consult per |
3 consult per |
4 consult per |
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services. |
Unlimited but subject to the aggregate annual limit per insured person per annum p/a* |
|||
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks) |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks) |
1 co-payment |
2 Co-payments / |
||
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS |
1 MRI / CT / PET |
2 scans per |
||
SUB-LIMITS*: INTERNAL PROSTHESES |
Up to R5 775* per |
Up to R11 550* per |
Unlimited |
|
SUB-LIMITS*: MRI / CT / PET SCAN |
1 |
2 |
||
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES |
Up to R13 650* per
Up to R3 780* per |
Up to R23 100* per
Up to R6 300* per |
||
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a |
||||
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital)
|
Up to R3 465* per |
Up to R9 240* per |
Up to R13 650* per |
Up to R23 100* per |
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 |
1 follow-up consultation |
1 follow-up consultation |
1 follow-up consultation |
GLOBAL FEE BENEFIT* |
Up to R12 600* per |
Up to R25 200* per |
||
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit) |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)* |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK) |
1 co-payment per |
2 Co-payments per |
||
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit) |
Up to R36 750* per |
Unlimited* |
||
ONCOLOGY “NEW-TECH” BENEFIT* |
Up to R8 610* per |
Up to R17 325* per |
||
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY* |
Up to R18 900* per |
Up to R36 750* per |
||
MEDICAL AID CONTRIBUTION WAIVER
Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed. |
6 months. |
6 months. |
6 months. |
|
Maternity Follow-Up Consultations
Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth |
Up to R7 00* per |
Up to R1 250* per |
||
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred. |
||||
For Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2 100 per day, for a total of 3 consecutive days |
||
For Non-Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2100 per day, for a total of 3 consecutive days |
||
ACCIDENTAL DEATH Insured / Spouse |
R7 350 |
R10 500 |
R21 000 |
R31 500 |
ACCIDENTAL DEATH Dependant |
R4 200 |
R5 775 |
R8 400 |
R21 000 |
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder) |
||||
TRAVEL BENEFIT |
||||
Emergency Medical and Related expenses up to R1 000 000. |
||||
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500. |
||||
Baggage Delay (more than 4 hours) R500 | ||||
Baggage Delay (more than 24 hours) R1 000 |
||||
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions. |
||||
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 380 | R 620 | |
Premium per Individual per policy per month |
R 99 | |||
Premium per Family per policy per month |
R 180 | |||
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 540 | R 570 | R 770 |
ALL SUPER COVER PLUS BENEFITS PLUS
Emergency Medical Services (ambulance)
From R620/m
ALL SUPER COVER PLUS BENEFITS WITH
HIGHER LIMIT AMOUNTS.
From R620/m
Basic Cover 300 | Vital Cover Plus | Super Cover Plus | Absolute Cover Plus | |
---|---|---|---|---|
Gap Cover Annual Limit R210 580 in aggregate per insured person per annum* (p/a) |
||||
Gap Cover Percentage* | 300% | 700% | 700% | 700% |
Tariff Shortfalls for Theatre and Ward Fees, Consumables, Laparoscopic/Endoscopic Equipment* 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 |
R1 000* per |
Up to R3 000* per |
Up to R5 000* per |
PMB's* Covered, subject to medical aid review |
||||
Shortfalls on Specialist Consultations* 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 |
2 consult per |
3 consult per |
4 consult per |
Emergency Medical Services (ambulance)* The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services. |
Unlimited but subject to the aggregate annual limit per insured person per annum p/a* |
|||
CO-PAYMENTS / DEDUCTIBLES* DSP’s (Voluntary use of designated service provider networks) |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
CO-PAYMENTS / DEDUCTIBLES* NON DSP’s (Voluntary use of non-designated service provider networks) |
1 co-payment |
2 Co-payments / |
||
CO-PAYMENT BENEFIT*: OUT OF HOSPITAL/MRI/CT/PET SCANS |
1 MRI / CT / PET |
2 scans per |
||
SUB-LIMITS*: INTERNAL PROSTHESES |
Up to R5 775* per |
Up to R11 550* per |
Unlimited |
|
SUB-LIMITS*: MRI / CT / PET SCAN |
1 |
2 |
||
SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES |
Up to R13 650* per
Up to R3 780* per |
Up to R23 100* per
Up to R6 300* per |
||
DENTAL BENEFIT* Unlimited but subject to the aggregate annual limit per insured person p/a |
||||
Casualty Unit Benefit (Casualty/ER Unit linked to a hospital)
|
Up to R3 465* per |
Up to R9 240* per |
Up to R13 650* per |
Up to R23 100* per |
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 |
1 follow-up consultation |
1 follow-up consultation |
1 follow-up consultation |
GLOBAL FEE BENEFIT* |
Up to R12 600* per |
Up to R25 200* per |
||
ONCOLOGY GAP BENEFIT* (Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit) |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
Unlimited but subject to the aggregate annual limit per insured person per annum |
ONCOLOGY CO-PAYMENT BENEFIT (IN NETWORK)* |
Up to R13 650* per |
Up to R63 000* per |
Unlimited* |
|
ONCOLOGY CO-PAYMENT BENEFIT* (OUT OF NETWORK) |
1 co-payment per |
2 Co-payments per |
||
ONCOLOGY EXTENDER BENEFIT* (Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit) |
Up to R36 750* per |
Unlimited* |
||
ONCOLOGY “NEW-TECH” BENEFIT* |
Up to R8 610* per |
Up to R17 325* per |
||
ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY* |
Up to R18 900* per |
Up to R36 750* per |
||
MEDICAL AID CONTRIBUTION WAIVER
Provides cover towards a policyholder's medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed. |
6 months. |
6 months. |
6 months. |
|
Maternity Follow-Up Consultations
Cover for the shortfall on a specialist shortfall (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth |
Up to R7 00* per |
Up to R1 250* per |
||
Private Ward Benefit The shortfall between the General Ward Rate and the Private Ward Rate for hospitalisation where an admission to a Private Ward occurred. |
||||
For Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2 100 per day, for a total of 3 consecutive days |
||
For Non-Childbirth |
Limited to a maximum of R525 per day, for a total of 3 consecutive days |
Limited to a maximum of R2100 per day, for a total of 3 consecutive days |
||
ACCIDENTAL DEATH Insured / Spouse |
R7 350 |
R10 500 |
R21 000 |
R31 500 |
ACCIDENTAL DEATH Dependant |
R4 200 |
R5 775 |
R8 400 |
R21 000 |
POLICY EXTENDER (Additional 12 month gap cover premiums covered upon accidental death of policyholder) |
||||
TRAVEL BENEFIT |
||||
Emergency Medical and Related expenses up to R1 000 000. |
||||
Theft, Damage or loss by Airline R5 000. / Single item limit: R1 500. |
||||
Baggage Delay (more than 4 hours) R500 | ||||
Baggage Delay (more than 24 hours) R1 000 |
||||
TRA ASSIST POWERED BY MobiMed Home Drive (including Uber), Panic Button (includes a Roadguard service), Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE) and Claims Submissions. |
||||
Monthly Premiums: Under 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 380 | R 620 | |
Premium per Individual per policy per month |
R 99 | |||
Premium per Family per policy per month |
R 180 | |||
Over 65's (Based on the age of the oldest Beneficiary) premium per policy per month. |
R 360 | R 540 | R 570 | R 770 |
*SUBJECT TO AN AGGREGATE ANNUAL LIMIT OF R210 580 PER INSURED PERSON
This limit may be subject to regulatory amendment. Sub-Limits may apply. Refer to the Policy Document for full details of limitations and exclusions.
Terms and Conditions apply. This product comparison 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. Errors and Omissions Excepted. A full list of 2025 terms and conditions can be viewed here.
With TRA, signing up for Gap Cover is a breeze. In just 5 minutes, you can secure comprehensive coverage that fills the gaps in your medical aid shortfalls.
Not sure if you need Gap Cover?
Just tell us about yourself and your medical aid, and we’ll let you know if it’s important for you. Here, we make finding the right gap cover easy. With our simple tools and expert help, you’ll quickly find the perfect policy for your needs.
WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES
AND WHAT YOUR MEDICAL AID PAYS.
WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES AND WHAT YOUR MEDICAL AID PAYS.
Gap Cover eliminates financial stress in case of hospitalisation by protecting you from medical shortfalls. Never assume that your medical aid will cover 100% of your in-hospital expenses.
Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.
Gap Cover eliminates financial stress in case of hospitalisation by protecting you from medical shortfalls. Never assume that your medical aid will cover 100% of your in-hospital expenses.
Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.
At TRA, we use the Net Promoter Score (NPS) to understand how likely you are to recommend us. We simply ask: “Would you recommend TRA to a friend or colleague?” Your answer helps us gauge your satisfaction and identify areas for improvement.