| Gap Cover Annual LimitR226 881 in aggregate per insured person per annum* (p/a) |  | |  |  |  |
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| Gap Cover Percentage* | 100% | 300% | 700% | 700% | 700% |
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| 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.) | —Not included | R525* per policy p/a* | R1 050* per policy p/a* | R3 150* per policy p/a* | R5 250* per policy p/a* |
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| Tariff Shortfall for Targeted Pain Relief*Pain Relief Benefit – Provides cover for targeted pain relief treatment during surgery or following a severe trauma. This is covered even if the medical aid pays from day-to- day benefits or savings, provided the treatment forms part of an authorised in-hospital procedure, funded from the medical aid’s Risk or Major Medical Benefit. | —Not included | 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 |
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| Tariff Shortfall Benefit for Hospitalised Psychiatric Care*Tariff Shortfall cover for service provider costs related to in-hospital mental health admissions requiring psychiatric care. | —Not included | 21 days* | 21 days* | 21 days* | 21 days* |
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| Step-Down facility Benefit*A once-off lump sum from day 11 onwards for extended stays in a registered step-down or sub-acute care facility following hospitalisation. | —Not included | —Not included | —Not included | R8 000* per insured person per annum | R12 000* per insured person per annum |
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| PMB’s*Covered, subject to medical aid review | | | | | |
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| 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) | —Not included | 1 consult per policy p/a* | 2 consults per policy p/a* | 3 consults per policy p/a* | 4 consults per policy p/a* |
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| Emergency Medical Services (Ambulance)*The shortfall related to the use of Out-of-Network (Non-DSP) emergency medical services. | —Not included | —Not included | —Not included | —Not included | Unlimited* |
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| Co-Payments/Deductibles (DSP’s)*DSP’s (Voluntary use of designated service provider networks) | In Network onlyR7 875 per policy per annum | —Not included | Up to R14 335* per policy p/a | Up to R66 150* per policy p/a | Unlimited* |
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| Co-Payments/Deductibles (Non-DSP’s)*NON DSP’s (Voluntary use of non-designated service provider networks) | —Not included | —Not included | —Not included | 1 co-payment per policy per annum. Up to R5 513* | 2 Co-payments / deductibles per policy per annum to a combined maximum of R17 640* |
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| Co-Payment Benefit (Out Of Hospital MRI/CT/PET Scans)* | —Not included | —Not included | —Not included | 1 MRI / CT / PET scan per policy p/a up to R13 230* | 2 scans per policy p/a. Unlimited but subject to the aggregate annual limit per insured person p/a* |
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| Sub-Limits*: Internal Prostheses | —Not included | —Not included | Up to R5 775* per policy p/a | Up to R12 128* per policy p/a | Unlimited*Up to R71 663* per event |
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| Sub-Limits*: MRI / CT / PET ScansThe shortfall on a service provider account that is not covered because you have reached the sub-limit for MRI / CT / PET scans imposed by your medical aid AND which has been authorised and paid from the In-Hospital or Major Medical benefit. | —Not included | —Not included | —Not included | 1 MRI, CT or PET scan up to R3 969* per scan | 2 MRI, CT or PET scans up to R6 615* per scan |
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| Sub-Limits*: Colonoscopies & GastroscopiesThe shortfall on a service provider account that is not covered because you have reached the sub-limit for Colonoscopies and Gastroscopies imposed by your medical aid AND which has been authorised and paid from the In-Hospital or Major Medical benefit. | —Not included | —Not included | —Not included | Up to R14 333* per policy per annumUp to R3 780* per event | Up to R24 225* per insured person per annumUp to R6 300* per event |
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| Dental Benefit*Unlimited but subject to the aggregate annual limit per insured person p/a | | | | | |
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| Casualty Unit Benefit*(Casualty/ER Unit linked to a hospital)Accidents only.Children under the age of 8 ONLY – May be admitted for any treatment between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday. | —Not included | Up to R3 640* per policy p/a | Up to R9 700* per policy p/a | Up to R14 335* per policy p/a | Up to R24 225* per policy p/a |
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| Casualty Follow-Up Consultations*(The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.) | —Not included | 1 follow-up consultation per policy p/a at an ER unit (accident-related only) | 1 follow-up consultation per policy p/a at an ER unit (accident-related only) | 1 follow-up consultation per policy p/a at an ER unit (accident-related only) | 1 follow-up consultation per policy p/a at an ER unit (accident-related only) |
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| Global Fee Benefit* | —Not included | —Not included | —Not included | Up to R13 230* per policy p/a | Up to R26 460* per policy p/a |
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| Oncology Gap Benefit*(Subject to medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit) | —Not included | | | | |
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| Oncology Co-Payment Benefit (In Network)* | —Not included | —Not included | Up to R14 333* per policy p/a | Up to R66 150* per policy p/a | Unlimited* |
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| Oncology Co-Payment Benefit (Out Of Network)* | —Not included | —Not included | —Not included | 1 co-payment per policy per annum. Up to R5 513* | 2 Co-payments per policy per annum up to a combined limit of R17 640* |
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| Oncology Extender Benefit*(Includes ANY costs above annual scheme oncology limit but subject to scheme covering up to this limit) | —Not included | —Not included | —Not included | Up to R38 588* per policy p/a* | Unlimited* |
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| Oncology “New-Tech” Benefit* | —Not included | —Not included | —Not included | Up to R9 040* per policy p/a* | Up to R18 191* per policy p/a |
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| Oncology Gap Benefit: Breast Reconstruction Surgery*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 related breast reconstruction surgery, including the unaffected breast. (NB: Subject to the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within the annual scheme oncology limit). | —Not included | —Not included | —Not included | Up to R19 845* per beneficiary per life of the policy | Up to R38 588* per beneficiary per life of the policy |
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| Premature Birth Benefit*A fixed payout is provided in the event of a baby being born before 34 completed weeks of gestation. (Excludes elective deliveries). | —Not included | —Not included | —Not included | R15 000* per policy per annum | R20 000* per policy per annum |
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| Medical Aid Contribution WaiverProvides 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. | —Not included | —Not included | 6 months. Up to a max of R4 850* per month. | 6 months. Up to a max of R6 060* per month. | 6 months. Up to a max of R7 275* per month. |
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| 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 | —Not included | —Not included | | Up to R735* per policy p/a | Up to R1 313* per policy p/a |
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| 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. | Maternity (childbirth)R1 050 per day, 3 consecutive days | —Not included | —Not included | For Childbirth: Limited to a maximum of R550* per day, for a total of 3 consecutive daysFor Non-Childbirth: Limited to a maximum of R550* per day, for a total of 3 consecutive days | For Childbirth: Limited to a maximum of R2 205* per day, for a total of 3 consecutive daysFor Non-Childbirth: Limited to a maximum of R2 205* per day, for a total of 3 consecutive days |
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| Accidental DeathInsured / SpouseDependant | Insured: R6 300Dependant: R3 150 | Insured / Spouse: R7 700Dependant: R4 400 | Insured / Spouse: R11 000Dependant: R6 060 | Insured / Spouse: R22 000Dependant: R8 800 | Insured / Spouse: R33 000Dependant: R22 000 |
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| Policy Extender (12 Months)(Additional 12 month gap cover premiums covered upon accidental death of policyholder) | —Not included | | | | |
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| Travel BenefitsEmergency Medical and Related expenses up to R1 000 000Theft, Damage or loss by Airline R5 000. – Single item limit: R1 500.Baggage Delay (more than 4 hours) R500Baggage Delay (more than 24 hours) R1 000Click HERE for more details. In addition, you may purchase a top-up plan by clicking HERE. As a TRA policyholder, you also qualify for an eSIM discount. Contact TRA for more information on this. | | | | | |
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| TRA ASSIST POWERED BY MobiMedHome Drive (including Uber)Panic Button (includes a Roadguard service)Medical Health Line & Trauma Counselling Line (includes a COVID-19 CARE LINE)Claims Submissions. | | | | | |
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| Monthly PremiumsUnder 65’s (Based on the age of the oldest Beneficiary) premium per policy per month.Premium per Individual per policy per monthPremium per Family per policy per monthOver 65’s (Based on the age of the oldest Beneficiary) premium per policy per month. | 0 – 30 years: R69 Single / R161 Family31 – 40 years: R117 Single / R198 Family41+ years: R296 Single / R351 Family | Under 65’s – Individual: R99Under 65’s – Family: R197Over 65’s: R394 | Under 65’s: R394Over 65’s: R591 | Under 65’s: R417Over 65’s: R626 | Under 65’s: R681Over 65’s: R846 |
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