total risk administrators (TRA) logo

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.

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.

WHAT TRA GAP COVER PROVIDES

TRA Gap Cover offers four tailor-made products that fit your needs based on your medical aid plan.

We know gap cover can be the difference between falling into debt and recovering from in-hospital expenses.

We help in the only way we know how: making our claims process one of the fastest in South Africa.

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SOUTH AFRICAN
GAP COVER PRODUCTSby TRA that cover your needs

SOUTH AFRICAN
GAP COVER PRODUCTSby TRA that cover
your needs

Basic Cover 300

OUR ENTRY LEVEL PRODUCT

STANDARD BENEFITS
Gap Cover
Casualty Cover
Oncology Gap
Policy Extender
Accidental Death Cover
TRA Assist Powered by MobiMed

From R99/m

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Basic Cover 300

OUR ENTRY LEVEL PRODUCT
Young family sitting on the couch smiling

STANDARD BENEFITS
Gap Cover
Casualty Cover
Oncology Gap
Policy Extender
Accidental Death Cover
TRA Assist Powered by MobiMed

From R99/m

Compare all products
Basic Cover 300 Vital Cover Plus Super Cover Plus Absolute Cover Plus
Gap Cover Annual Limit

R198 660 in aggregate per
insured person per annum*
(p/a)
Gap Cover Percentage* 300% 700% 700% 700%
PMB's*
Covered, subject to medical
aid review
CO-PAYMENTS /
DEDUCTIBLES*

DSP’s (Voluntary use of
designated service provider
networks)

Up to R13 000* per
policy p/a*

Up to R60 000* per
policy p/a*

Unlimited*

CO-PAYMENTS /
DEDUCTIBLES*

NON DSP’s (Voluntary use of
non-designated service
provider networks)

1 co-payment
per policy
per annum.
Up to R5 000*

2 Co-payments /
deductibles per
policy per annum
to a combined
maximum of R16
000*

CO-PAYMENT BENEFIT*: OUT
OF HOSPITAL/MRI/CT/PET
SCANS

1 MRI / CT / PET
scan per policy p/a
up to R12 000*

2 scans per
policy
p/a. Unlimited
but subject to the
aggregate annual
limit per insured
person p/a*

SUB-LIMITS*: INTERNAL
PROSTHESES

Up to R5 500* per
policy p/a

Up to R11 000* per
policy p/a

Unlimited
Up to R65
000* per event

SUB-LIMITS*: MRI / CT / PET
SCAN

1
MRI, CT or PET
scan up to
R3 600* per scan

2
MRI, CT or PET
scan up
to R6 000*
per scan

SUB-LIMITS*:
COLONOSCOPIES AND
GASTROSCOPIES

Up to R13 000* per
policy per annum

Up to R3 600* per
event

Up to R22 000* per
insured person per annum

Up to R6 000* per
event

DENTAL BENEFIT*
Unlimited but subject to
the aggregate annual limit
per insured person p/a
CASUALTY UNIT BENEFIT*

Up to R3 300* per
policy p/a

Up to R8 800* per
policy p/a

Up to R13 000* per
policy p/a

Up to R22 000* per
policy p/a

GLOBAL FEE BENEFIT*

Up to R12 000* per
policy p/a

Up to R24 000* per
policy p/a

ONCOLOGY GAP BENEFIT*
(Subject to medical aid
approved treatment plan
being covered up to scheme
tariff and within annual
scheme oncology limit)

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

ONCOLOGY CO-PAYMENT
BENEFIT (IN NETWORK)*

Up to R13 000* per
policy p/a

Up to R60 000* per
policy p/a

Unlimited*

ONCOLOGY CO-PAYMENT
BENEFIT* (OUT OF
NETWORK)

1 co-payment per
policy per annum.
Up to R5 000*

2 Co-payments per
policy per annum
up to a combined
limit of R16 000*

ONCOLOGY EXTENDER
BENEFIT*

(Includes ANY costs above
annual scheme oncology
limit but subject to scheme
covering up to this limit)

Up to R35 000* per
policy per
annum

Unlimited*

ONCOLOGY “NEW-TECH”
BENEFIT*

Up to R8 200* per
policy p/a

Up to R16 500* per
policy p/a

ONCOLOGY GAP BENEFIT:
BREAST RECONSTRUCTION
SURGERY*

Up to R18 000* per
policy p/a

Up to R35 000* per
policy p/a

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.
Up to a max of R4 400 per month.

6 months.
Up to a max of R5 500 per month.

6 months.
Up to a max of R6 600 per month.

MATERNITY PRIVATE WARD
BENEFIT*

Limited to a
maximum of R5
00*
per day, for a
total of 3
consecutive days

Limited to a
maximum of R2
000*
per day, for a
total of 3
consecutive days

ACCIDENTAL DEATH
Insured / Spouse

R7 000

R10 000

R20 000

R30 000

ACCIDENTAL DEATH
Dependant

R4 000

R5 500

R8 000

R20 000

POLICY EXTENDER
(Additional 12 month gap
cover premiums covered
upon accidental death of
policyholder)
TRAVEL BENEFIT
Benefits include but are
not limited to:
Emergency Medical and
Related expenses : R600
000. Excess R500
COVID-19 Extension:
Emergency inpatient or
outpatient treatment due
to COVID-19 R600 000.
Medical evacuation,
repatriation or
transportation to a medical
centre - FULL COST covered
when arranged by Hepstar.
Hospital Cash
benefit R500 per day (max
R3 000).
Inconvenience Cover:
Baggage Cover: R5 000 for
theft, damage or loss by
travel supplier.
TRA ASSIST POWERED BY
MobiMed
Home Drive (including
Uber), Panic Button,
Medical Health Line,
Trauma Counselling Line
(includes a COVID-19
CARE LINE) and Claims
Submissions.

Vital Cover Plus

Our 2nd entry level product

ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover
Sub-Limit Cover

From R300/m

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Vital Cover Plus

Our 2nd entry level product
Young family sitting on the couch smiling

ALL BASIC COVER BENEFITS PLUS
In Network Co-Payment Cover
Sub-Limit Cover

From R300/m

Compare all products
Basic Cover 300 Vital Cover Plus Super Cover Plus Absolute Cover Plus
Gap Cover Annual Limit

R198 660 in aggregate per
insured person per annum*
(p/a)
Gap Cover Percentage* 300% 700% 700% 700%
PMB's*
Covered, subject to medical
aid review
CO-PAYMENTS /
DEDUCTIBLES*

DSP’s (Voluntary use of
designated service provider
networks)

Up to R13 000* per
policy p/a*

Up to R60 000* per
policy p/a*

Unlimited*

CO-PAYMENTS /
DEDUCTIBLES*

NON DSP’s (Voluntary use of
non-designated service
provider networks)

1 co-payment
per policy
per annum.
Up to R5 000*

2 Co-payments /
deductibles per
policy per annum
to a combined
maximum of R16
000*

CO-PAYMENT BENEFIT*: OUT
OF HOSPITAL/MRI/CT/PET
SCANS

1 MRI / CT / PET
scan per policy p/a
up to R12 000*

2 scans per
policy
p/a. Unlimited
but subject to the
aggregate annual
limit per insured
person p/a*

SUB-LIMITS*: INTERNAL
PROSTHESES

Up to R5 500* per
policy p/a

Up to R11 000* per
policy p/a

Unlimited
Up to R65
000* per event

SUB-LIMITS*: MRI / CT / PET
SCAN

1
MRI, CT or PET
scan up to
R3 600* per scan

2
MRI, CT or PET
scan up
to R6 000*
per scan

SUB-LIMITS*:
COLONOSCOPIES AND
GASTROSCOPIES

Up to R13 000* per
policy per annum

Up to R3 600* per
event

Up to R22 000* per
insured person per annum

Up to R6 000* per
event

DENTAL BENEFIT*
Unlimited but subject to
the aggregate annual limit
per insured person p/a
CASUALTY UNIT BENEFIT*

Up to R3 300* per
policy p/a

Up to R8 800* per
policy p/a

Up to R13 000* per
policy p/a

Up to R22 000* per
policy p/a

GLOBAL FEE BENEFIT*

Up to R12 000* per
policy p/a

Up to R24 000* per
policy p/a

ONCOLOGY GAP BENEFIT*
(Subject to medical aid
approved treatment plan
being covered up to scheme
tariff and within annual
scheme oncology limit)

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

ONCOLOGY CO-PAYMENT
BENEFIT (IN NETWORK)*

Up to R13 000* per
policy p/a

Up to R60 000* per
policy p/a

Unlimited*

ONCOLOGY CO-PAYMENT
BENEFIT* (OUT OF
NETWORK)

1 co-payment per
policy per annum.
Up to R5 000*

2 Co-payments per
policy per annum
up to a combined
limit of R16 000*

ONCOLOGY EXTENDER
BENEFIT*

(Includes ANY costs above
annual scheme oncology
limit but subject to scheme
covering up to this limit)

Up to R35 000* per
policy per
annum

Unlimited*

ONCOLOGY “NEW-TECH”
BENEFIT*

Up to R8 200* per
policy p/a

Up to R16 500* per
policy p/a

ONCOLOGY GAP BENEFIT:
BREAST RECONSTRUCTION
SURGERY*

Up to R18 000* per
policy p/a

Up to R35 000* per
policy p/a

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.
Up to a max of R4 400 per month.

6 months.
Up to a max of R5 500 per month.

6 months.
Up to a max of R6 600 per month.

MATERNITY PRIVATE WARD
BENEFIT*

Limited to a
maximum of R5
00*
per day, for a
total of 3
consecutive days

Limited to a
maximum of R2
000*
per day, for a
total of 3
consecutive days

ACCIDENTAL DEATH
Insured / Spouse

R7 000

R10 000

R20 000

R30 000

ACCIDENTAL DEATH
Dependant

R4 000

R5 500

R8 000

R20 000

POLICY EXTENDER
(Additional 12 month gap
cover premiums covered
upon accidental death of
policyholder)
TRAVEL BENEFIT
Benefits include but are
not limited to:
Emergency Medical and
Related expenses : R600
000. Excess R500
COVID-19 Extension:
Emergency inpatient or
outpatient treatment due
to COVID-19 R600 000.
Medical evacuation,
repatriation or
transportation to a medical
centre - FULL COST covered
when arranged by Hepstar.
Hospital Cash
benefit R500 per day (max
R3 000).
Inconvenience Cover:
Baggage Cover: R5 000 for
theft, damage or loss by
travel supplier.
TRA ASSIST POWERED BY
MobiMed
Home Drive (including
Uber), Panic Button,
Medical Health Line,
Trauma Counselling Line
(includes a COVID-19
CARE LINE) and Claims
Submissions.

Super Cover Plus

Our mid-range product

ALL VITAL COVER BENEFITS PLUS
Global Fee Benefit
Breast Reconstruction Surgery Benefit
Co-Payment: Out Of Hospital MRI/CT/PET Scans
Out of Network Co-Payment Cover
Oncology “New Tech” Benefit
Maternity Private Ward Benefit

From R330/m

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Super Cover Plus

Our mid-range product
Young family sitting on the couch smiling

ALL VITAL COVER BENEFITS PLUS
Global Fee Benefit
Breast Reconstruction Surgery Benefit
Co-Payment: Out Of Hospital MRI/CT/PET Scans (2023)
Out of Network Co-Payment Cover
Oncology “New Tech” Benefit
Maternity Private Ward Benefit

From R330/m

COMPARE ALL PRODUCTS
Basic Cover 300 Vital Cover Plus Super Cover Plus Absolute Cover Plus
Gap Cover Annual Limit

R198 660 in aggregate per
insured person per annum*
(p/a)
Gap Cover Percentage* 300% 700% 700% 700%
PMB's*
Covered, subject to medical
aid review
CO-PAYMENTS /
DEDUCTIBLES*

DSP’s (Voluntary use of
designated service provider
networks)

Up to R13 000* per
policy p/a*

Up to R60 000* per
policy p/a*

Unlimited*

CO-PAYMENTS /
DEDUCTIBLES*

NON DSP’s (Voluntary use of
non-designated service
provider networks)

1 co-payment
per policy
per annum.
Up to R5 000*

2 Co-payments /
deductibles per
policy per annum
to a combined
maximum of R16
000*

CO-PAYMENT BENEFIT*: OUT
OF HOSPITAL/MRI/CT/PET
SCANS

1 MRI / CT / PET
scan per policy p/a
up to R12 000*

2 scans per
policy
p/a. Unlimited
but subject to the
aggregate annual
limit per insured
person p/a*

SUB-LIMITS*: INTERNAL
PROSTHESES

Up to R5 500* per
policy p/a

Up to R11 000* per
policy p/a

Unlimited
Up to R65
000* per event

SUB-LIMITS*: MRI / CT / PET
SCAN

1
MRI, CT or PET
scan up to
R3 600* per scan

2
MRI, CT or PET
scan up
to R6 000*
per scan

SUB-LIMITS*:
COLONOSCOPIES AND
GASTROSCOPIES

Up to R13 000* per
policy per annum

Up to R3 600* per
event

Up to R22 000* per
insured person per annum

Up to R6 000* per
event

DENTAL BENEFIT*
Unlimited but subject to
the aggregate annual limit
per insured person p/a
CASUALTY UNIT BENEFIT*

Up to R3 300* per
policy p/a

Up to R8 800* per
policy p/a

Up to R13 000* per
policy p/a

Up to R22 000* per
policy p/a

GLOBAL FEE BENEFIT*

Up to R12 000* per
policy p/a

Up to R24 000* per
policy p/a

ONCOLOGY GAP BENEFIT*
(Subject to medical aid
approved treatment plan
being covered up to scheme
tariff and within annual
scheme oncology limit)

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

ONCOLOGY CO-PAYMENT
BENEFIT (IN NETWORK)*

Up to R13 000* per
policy p/a

Up to R60 000* per
policy p/a

Unlimited*

ONCOLOGY CO-PAYMENT
BENEFIT* (OUT OF
NETWORK)

1 co-payment per
policy per annum.
Up to R5 000*

2 Co-payments per
policy per annum
up to a combined
limit of R16 000*

ONCOLOGY EXTENDER
BENEFIT*

(Includes ANY costs above
annual scheme oncology
limit but subject to scheme
covering up to this limit)

Up to R35 000* per
policy per
annum

Unlimited*

ONCOLOGY “NEW-TECH”
BENEFIT*

Up to R8 200* per
policy p/a

Up to R16 500* per
policy p/a

ONCOLOGY GAP BENEFIT:
BREAST RECONSTRUCTION
SURGERY*

Up to R18 000* per
policy p/a

Up to R35 000* per
policy p/a

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.
Up to a max of R4 400 per month.

6 months.
Up to a max of R5 500 per month.

6 months.
Up to a max of R6 600 per month.

MATERNITY PRIVATE WARD
BENEFIT*

Limited to a
maximum of R5
00*
per day, for a
total of 3
consecutive days

Limited to a
maximum of R2
000*
per day, for a
total of 3
consecutive days

ACCIDENTAL DEATH
Insured / Spouse

R7 000

R10 000

R20 000

R30 000

ACCIDENTAL DEATH
Dependant

R4 000

R5 500

R8 000

R20 000

POLICY EXTENDER
(Additional 12 month gap
cover premiums covered
upon accidental death of
policyholder)
TRAVEL BENEFIT
Benefits include but are
not limited to:
Emergency Medical and
Related expenses : R600
000. Excess R500
COVID-19 Extension:
Emergency inpatient or
outpatient treatment due
to COVID-19 R600 000.
Medical evacuation,
repatriation or
transportation to a medical
centre - FULL COST covered
when arranged by Hepstar.
Hospital Cash
benefit R500 per day (max
R3 000).
Inconvenience Cover:
Baggage Cover: R5 000 for
theft, damage or loss by
travel supplier.
TRA ASSIST POWERED BY
MobiMed
Home Drive (including
Uber), Panic Button,
Medical Health Line,
Trauma Counselling Line
(includes a COVID-19
CARE LINE) and Claims
Submissions.

Absolute Cover Plus

Our flagship product

ALL SUPER COVER BENEFITS WITH
HIGHER LIMIT AMOUNTS.
Maternity Private Ward Benefit
Oncology Extender Benefits

From R590/m

Young family sitting on the couch smiling

Absolute Cover Plus

Our flagship product
Young family sitting on the couch smiling

ALL SUPER COVER BENEFITS WITH
HIGHER LIMIT AMOUNTS.
Maternity Private Ward Benefit
Oncology Extender Benefits

From R590/m

Compare all products
Basic Cover 300 Vital Cover Plus Super Cover Plus Absolute Cover Plus
Gap Cover Annual Limit

R198 660 in aggregate per
insured person per annum*
(p/a)
Gap Cover Percentage* 300% 700% 700% 700%
PMB's*
Covered, subject to medical
aid review
CO-PAYMENTS /
DEDUCTIBLES*

DSP’s (Voluntary use of
designated service provider
networks)

Up to R13 000* per
policy p/a*

Up to R60 000* per
policy p/a*

Unlimited*

CO-PAYMENTS /
DEDUCTIBLES*

NON DSP’s (Voluntary use of
non-designated service
provider networks)

1 co-payment
per policy
per annum.
Up to R5 000*

2 Co-payments /
deductibles per
policy per annum
to a combined
maximum of R16
000*

CO-PAYMENT BENEFIT*: OUT
OF HOSPITAL/MRI/CT/PET
SCANS

1 MRI / CT / PET
scan per policy p/a
up to R12 000*

2 scans per
policy
p/a. Unlimited
but subject to the
aggregate annual
limit per insured
person p/a*

SUB-LIMITS*: INTERNAL
PROSTHESES

Up to R5 500* per
policy p/a

Up to R11 000* per
policy p/a

Unlimited
Up to R65
000* per event

SUB-LIMITS*: MRI / CT / PET
SCAN

1
MRI, CT or PET
scan up to
R3 600* per scan

2
MRI, CT or PET
scan up
to R6 000*
per scan

SUB-LIMITS*:
COLONOSCOPIES AND
GASTROSCOPIES

Up to R13 000* per
policy per annum

Up to R3 600* per
event

Up to R22 000* per
insured person per annum

Up to R6 000* per
event

DENTAL BENEFIT*
Unlimited but subject to
the aggregate annual limit
per insured person p/a
CASUALTY UNIT BENEFIT*

Up to R3 300* per
policy p/a

Up to R8 800* per
policy p/a

Up to R13 000* per
policy p/a

Up to R22 000* per
policy p/a

GLOBAL FEE BENEFIT*

Up to R12 000* per
policy p/a

Up to R24 000* per
policy p/a

ONCOLOGY GAP BENEFIT*
(Subject to medical aid
approved treatment plan
being covered up to scheme
tariff and within annual
scheme oncology limit)

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

Up to an
aggregate
of R198 660* per
insured person p/a

ONCOLOGY CO-PAYMENT
BENEFIT (IN NETWORK)*

Up to R13 000* per
policy p/a

Up to R60 000* per
policy p/a

Unlimited*

ONCOLOGY CO-PAYMENT
BENEFIT* (OUT OF
NETWORK)

1 co-payment per
policy per annum.
Up to R5 000*

2 Co-payments per
policy per annum
up to a combined
limit of R16 000*

ONCOLOGY EXTENDER
BENEFIT*

(Includes ANY costs above
annual scheme oncology
limit but subject to scheme
covering up to this limit)

Up to R35 000* per
policy per
annum

Unlimited*

ONCOLOGY “NEW-TECH”
BENEFIT*

Up to R8 200* per
policy p/a

Up to R16 500* per
policy p/a

ONCOLOGY GAP BENEFIT:
BREAST RECONSTRUCTION
SURGERY*

Up to R18 000* per
policy p/a

Up to R35 000* per
policy p/a

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.
Up to a max of R4 400 per month.

6 months.
Up to a max of R5 500 per month.

6 months.
Up to a max of R6 600 per month.

MATERNITY PRIVATE WARD
BENEFIT*

Limited to a
maximum of R5
00*
per day, for a
total of 3
consecutive days

Limited to a
maximum of R2
000*
per day, for a
total of 3
consecutive days

ACCIDENTAL DEATH
Insured / Spouse

R7 000

R10 000

R20 000

R30 000

ACCIDENTAL DEATH
Dependant

R4 000

R5 500

R8 000

R20 000

POLICY EXTENDER
(Additional 12 month gap
cover premiums covered
upon accidental death of
policyholder)
TRAVEL BENEFIT
Benefits include but are
not limited to:
Emergency Medical and
Related expenses : R600
000. Excess R500
COVID-19 Extension:
Emergency inpatient or
outpatient treatment due
to COVID-19 R600 000.
Medical evacuation,
repatriation or
transportation to a medical
centre - FULL COST covered
when arranged by Hepstar.
Hospital Cash
benefit R500 per day (max
R3 000).
Inconvenience Cover:
Baggage Cover: R5 000 for
theft, damage or loss by
travel supplier.
TRA ASSIST POWERED BY
MobiMed
Home Drive (including
Uber), Panic Button,
Medical Health Line,
Trauma Counselling Line
(includes a COVID-19
CARE LINE) and Claims
Submissions.

*SUBJECT TO AN AGGREGATE ANNUAL LIMIT OF R198 660 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 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. Errors and Omissions Excepted. A full list of 2024 terms and conditions can be viewed here

DON’T STRESS!

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.

ALL OF OUR GAP COVER POLICIES

  • Don’t add financial stress for you and your family if you have to be hospitalised.
  • Provide benefits for you and your spouse and those financially dependent on them (child/children and/or aged parents) who are covered on one policy of a registered medical aid scheme. Subject to proof of membership and the premium being based on the age of the oldest beneficiary. Members and their dependants can also be on two different medical aids and one Gap Cover Policy but only if they are legally married, or common law partners verified by submission of an affidavit confirming 12 months of cohabitation.
Young couple with a baby
Young family on the beach
  • Have no entry age limit.
  • May allow for immediate gap cover 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 gap 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 (PMB’s) where a medical aid has failed to meet its obligations in this regard (Subject to medical aid review and for non-emergencies only).
  • Is not a medical aid scheme. Gap cover is not the same as that of a medical aid scheme. Gap cover is not a substitute for your medical aid scheme membership.
  • Are subject to the aggregate gap cover annual limit of R198 660 per insured person per annum. (This limit may change due to regulatory amendment).
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  • All of our 2023 product options offer the following TRA ASSIST (powered by eASSIST) benefits – Home drive – Panic Button – Medical and Trauma Counselling-Line (now includes a COVID- 19 Care Line).
  • Gap Cover is the only way to protect yourself from medical shortfalls. Never assume that your medical aid will always cover 100% of your in-hospital expenses. Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.

Gap Cover is an affordable health insurance policy that gives you and your family peace of mind when you need it most.

Gap Cover is becoming a necessity in South Africa as doctors and medical aids continue to increase their rates exponentially each year.

Gap Cover is not a medical aid plan but has helped hundreds of South Africans avoid financial debt. You can visit our
Hello Peter page to find out how our policyholders feel about our service and Gap Cover products.

Gap Cover is an affordable health insurance policy that gives you and your family peace of mind when you need it most.

Gap Cover is becoming a necessity in South Africa as doctors and medical aids continue to increase their rates exponentially each year.

Gap Cover is not a medical aid plan but has helped hundreds of South Africans avoid financial debt. You can visit our
Hello Peter page to find out how our policyholders feel about our service and Gap Cover products.

ALL OF OUR GAP COVER POLICIES:

  • Eliminate financial strain in times of medical emergencies.
  • Provide benefits for your entire family, as long as they are covered on one policy of a registered medical aid scheme.
  • Are subject to terms and conditions.
  • Have no entry age limit.
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  • Have no waiting period for many specific procedures. These may include all emergency procedures, tonsillectomies, appendectomies, gall bladder removal, and others not explicitly excluded.
  • Provide immediate gap cover benefits for all policyholders except for a limited list of specific conditions and procedures.
  • May provide immediate gap cover for many procedures, including 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.
  • Are not a substitute for your medical aid scheme membership; it is not a medical scheme.
  • Are subject to the aggregate gap cover annual limit of R198 660 per insured person per annum (subject to amendment).
Happy family camping
Young family in home
  • Offer the following TRA ASSIST benefits: home drive, panic button, and medical and trauma counselling line.
  • Are the only way to protect yourself from medical shortfalls.

Gap Cover is an affordable health insurance policy that gives you and your family peace of mind when you need it most.

Gap Cover is becoming a necessity in South Africa as doctors and medical aids continue to increase their rates exponentially each year.

Gap Cover is not a medical aid plan but has helped hundreds of South Africans avoid financial debt. You can visit our
Hello Peter page to find out how our policyholders feel about our service and Gap Cover products.

Gap Cover is an affordable health insurance policy that gives you and your family peace of mind when you need it most.

Gap Cover is becoming a necessity in South Africa as doctors and medical aids continue to increase their rates exponentially each year.

Gap Cover is not a medical aid plan but has helped hundreds of South Africans avoid financial debt. You can visit our
Hello Peter page to find out how our policyholders feel about our service and Gap Cover products.

FREQUENTLY ASKED QUESTIONS

What is Gap Cover?​

Gap Cover is an insurance policy that covers the difference between what your medical aid pays and what service providers charge for in-hospital expenses.

 

How do I claim from Gap Cover?

Claims – Manual and Automatic Processes

The policyholder is responsible for ensuring that claims are submitted and received by TRA within six (6) months from the treatment date. The policyholder should also ensure that TRA has the correct banking details into which we must pay the claim.

 

Claims – Manual Process

Policyholders need to submit the following:

  • The claim from the service provider.
  • The first two pages of the hospital account that show the hospital event’s admission and discharge dates.
  • The medical aid statement showing the payment of the service provider claim and the reason for the short payment.
  • You can email these claims documents to claims@totalrisksa.co.za or submit them via our website, www.totalrisksa.co.za or our mobile app, TRA Assist.
  • Alternatively, you can contact TRA directly at +27 (11) 372 1540. One of our highly qualified and friendly claims specialists will gladly assist.

 

Claims – Automatic Process

TRA receives claims submitted by selected medical aid schemes on behalf of the policyholder. Should your medical aid company have such an agreement with TRA, it is optional for the policyholder to submit their claim to TRA.

 

TRA will receive an electronic version of the claim and will process the said claim within seven working days of receipt thereof.

 

Co-payment and sub-limit claims must always be submitted manually by the policyholder (in addition to all the required claims documentation, please also provide proof of any direct payment/s made to these service providers).

 

Should a claim be rejected because additional information (e.g. pre-authorisation letter, medical aid statement, doctor’s account or the first two pages of the hospital account) is not received, all the information must be submitted to TRA within 31 days from the date of the request or the claim will be rejected as late/stale in terms of this policy and will not be paid.

Why do I need Gap Cover?

Most people purchase medical aid and assume they will take care of all their medical bills. Unfortunately, this is not always true. Medical shortfalls can occur if you need medical care for any reason – accident or illness. You don’t want to add financial worry to the stress of being hospitalised, which is why you need Gap Cover.

 

Gap Cover ensures you don’t receive a massive bill if there’s a shortfall between what the doctors charge and what your medical aid will pay for in-hospital procedures.

OUR LATEST NEWS

6 February 2024News, TRA News

The Best Gap Cover in South Africa: Going The exTRA Mile for their Clients

Gap cover has become an essential safeguard against unforeseen medical expenses for South Africans. With so many options available, understanding

18 January 2024News, TRA News

TRA’s Support for Out-of-Hospital Procedures

Total Risk Administrators (TRA) is committed to offering comprehensive gap cover for various out-of-hospital procedures. The following article expands on

Read More
8 January 2024News, TRA News

TRA’s Gap Cover Exclusion Policy

Policyholders need to understand that having medical aid does not guarantee that your insurer will cover all of your medical

Read More