Basic Cover 300

Our entry level product

Standard Benefits

Gap Cover

Casualty Cover

Oncology Gap

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from R99 p/m
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Vital Cover Plus

Our second entry level product

Standard Benefits

Gap Cover

Casualty Cover

Oncology Gap

Co-Payment Cover

Sub-Limit Cover

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from R180 p/m
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Super Cover Plus

Our mid-range product

Standard Benefits

Gap Cover

Casualty cover

Oncology Gap

Co-Payment Cover

Sub-Limit Cover

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from R227 p/m
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Absolute Cover Plus

Our flagship product

Standard Benefits

Gap Cover

Casualty cover

Oncology Gap

Co-Payment Cover

Sub-Limit Cover

Plus

Oncology Extender Benefits

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from R390 p/m
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Basic Cover 300

Our entry level product

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from R99 p/m
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Vital Cover Plus

Our 2nd entry level product

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from R180 p/m
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Super Cover Plus

Our mid-range product

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from R227 p/m
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Absolute Cover Plus

Our flagship product

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from R390 p/m
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Gap Cover Annual Limit

2019
R158 000 in aggregate per insured person per annum* (p/a)

2020
R165 000 in aggregate per insured person per annum* (p/a)

Gap Cover Annual Limit

2019
R158 000 in aggregate per insured person per annum* (p/a)

2020
R165 000 in aggregate per insured person per annum* (p/a)

Gap Cover Annual Limit

2019
R158 000 in aggregate per insured person per annum* (p/a)

2020
R165 000 in aggregate per insured person per annum* (p/a)

Gap Cover Annual Limit

2019
R158 000 in aggregate per insured person per annum* (p/a)

2020
R165 000 in aggregate per insured person per annum* (p/a)

Gap Cover Percentage*

300%*

Gap Cover Percentage*

700%*

Gap Cover Percentage*

700%*

Gap Cover Percentage*

700%*

PMB's Please Note:

If you are still on a ‘Non-Plus’ product option which is closed to new business i.e. 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.
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Covered

PMB's Please Note:

If you are still on a ‘Non-Plus’ product option which is closed to new business i.e. 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.
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Covered

PMB's Please Note:

If you are still on a ‘Non-Plus’ product option which is closed to new business i.e. 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.
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Covered

PMB's Please Note:

If you are still on a ‘Non-Plus’ product option which is closed to new business i.e. 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.
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Covered

Co-payments / deductibles*

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

None

Co-payments / deductibles*

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

Up to R10 000 per policy p/a*

Co-payments / deductibles*

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

Up to R50 000 per policy p/a*

Co-payments / deductibles*

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

Unlimited*

Co-payments / deductibles*

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

None

Co-payments / deductibles*

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

None

Co-payments / deductibles*

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

None

Co-payments / deductibles*

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

2 Co-payments / deductibles per policy per annum to a combined maximum of R14 000*

SUB-LIMITS*: Prostheses

None

SUB-LIMITS*: Prostheses

Up to R5 000 per policy p/a*

SUB-LIMITS*: Prostheses

Up to R10 000 per policy p/a*

SUB-LIMITS*: Prostheses

Unlimited.* Up to R30 000 per event.*

SUB-LIMITS*: MRI / CT / PET Scans

None

SUB-LIMITS*: MRI / CT / PET Scans

None

SUB-LIMITS*: MRI / CT / PET Scans

None

SUB-LIMITS*: MRI / CT / PET Scans

2 MRI, CT or PET scans up to R4 000 per scan*

CASUALTY UNIT BENEFIT*

Up to R2 750 per policy p/a*

CASUALTY UNIT BENEFIT*

2019
Up to R5 000 per policy p/a*

2020
Up to R7 500 per policy p/a*

CASUALTY UNIT BENEFIT*

2019
Up to R7 500 per policy p/a*

2020
Up to R10 000 per policy p/a*

CASUALTY UNIT BENEFIT*

2019
Up to R15 000 per policy p/a*

2020
Up to R20 000 per policy p/a*

GLOBAL FEE BENEFIT*

No Benefit

GLOBAL FEE BENEFIT*

No Benefit

GLOBAL FEE BENEFIT*

2019
No Benefit

2020
Up to R5 000 per policy p/a*

GLOBAL FEE BENEFIT*

2019
No Benefit

2020
Up to R10 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)

2019
Up to an aggregate of R158 000 per insured person p/a*

2020
Up to an aggregate of R165 000 per insured person p/a*

Oncology gap benefit*

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

2019
Up to an aggregate of R158 000 per insured person p/a*

2020
Up to an aggregate of R165 000 per insured person p/a*

Oncology gap benefit*

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

2019
Up to an aggregate of R158 000 per insured person p/a*

2020
Up to an aggregate of R165 000 per insured person p/a*

Oncology gap benefit*

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

2019
Up to an aggregate of R158 000 per insured person p/a*

2020
Up to an aggregate of R165 000 per insured person p/a*

Oncology co-payment Benefit*

None

Oncology co-payment Benefit*

Up to R10 000 per policy p/a*

Oncology co-payment Benefit*

Up to R50 000 per policy p/a*

Oncology co-payment Benefit*

Unlimited*

Oncology extender Benefit*

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

None

Oncology extender Benefit*

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

None

Oncology extender Benefit*

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

None

Oncology extender Benefit*

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

Unlimited*

ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*

No Benefit

ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*

No Benefit

ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*

2019
No Benefit

2020
Up to R10 000 per policy p/a*

ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*

2019
No Benefit

2020
Up to R10 000 per policy p/a*

Accidental death

Insured / Spouse

R3 000

Accidental death

Insured / Spouse

2019
R4 000

2020
R5 000

Accidental death

Insured / Spouse

2019
R6 000

2020
R7 500

Accidental death

Insured / Spouse

2019
R8 000

2020
R10 000

Accidental death

Dependant

R1 500

Accidental death

Dependant

2019
R2 000

2020
R2 500

Accidental death

Dependant

2019
R3 000

2020
R3 750

Accidental death

Dependant

2019
R4 000

2020
R5 000

Policy Extender

(Additional 6 month gap cover premiums covered upon death of policyholder)

Included

Policy Extender

(Additional 6 month gap cover premiums covered upon death of policyholder)

Included

Policy Extender

(Additional 6 month gap cover premiums covered upon death of policyholder)

Included

Policy Extender

(Additional 6 month gap cover premiums covered upon death of policyholder)

Included

TRA ASSIST POWERED BY ER24 ASSIST

2019
(Home Drive, Panic Button, Medical Health Line)

2020
Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line and Claims Submissions.

Included

Monthly Premium 2019
Under 65's

N/A

(Age of main insured)
premium per policy p/m

Over 65's

R300

(Age of main insured)
premium per policy p/m

Premium Per Individual

R99

per policy p/m

Premium Per Family

R150

per policy p/m

Monthly Premium 2020
Under 65's

N/A

(Age of main insured)
premium per policy p/m

Over 65's

R330

(Age of main insured)
premium per policy p/m

Premium Per Individual

R99

per policy p/m

Premium Per Family

R165

per policy p/m

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TRA ASSIST POWERED BY ER24 ASSIST

2019
(Home Drive, Panic Button, Medical Health Line)

2020
Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line and Claims Submissions.

Included

Monthly Premium 2019
Under 65's

R180

(Age of main insured)
premium per policy p/m

Over 65's

R270

(Age of main insured)
premium per policy p/m

Premium Per Individual

N/A

per policy p/m

Premium Per Family

N/A

per policy p/m

Monthly Premium 2020
Under 65's

R220

(Age of main insured)
premium per policy p/m

Over 65's

R330

(Age of main insured)
premium per policy p/m

Premium Per Individual

N/A

per policy p/m

Premium Per Family

N/A

per policy p/m

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R180 p/m
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TRA ASSIST POWERED BY ER24 ASSIST

2019
(Home Drive, Panic Button, Medical Health Line)

2020
Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line and Claims Submissions.

Included

Monthly Premium 2019
Under 65's

R227

(Age of main insured)
premium per policy p/m

Over 65's

R340

(Age of main insured)
premium per policy p/m

Premium Per Individual

N/A

per policy p/m

Premium Per Family

N/A

per policy p/m

Monthly Premium 2020
Under 65's

R250

(Age of main insured)
premium per policy p/m

Over 65's

R360

(Age of main insured)
premium per policy p/m

Premium Per Individual

N/A

per policy p/m

Premium Per Family

N/A

per policy p/m

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from R227 p/m
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TRA ASSIST POWERED BY ER24 ASSIST

2019
(Home Drive, Panic Button, Medical Health Line)

2020
Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line and Claims Submissions.

Included

Monthly Premium 2019
Under 65's

R390

(Age of main insured)
premium per policy p/m

Over 65's

R470

(Age of main insured)
premium per policy p/m

Premium Per Individual

N/A

per policy p/m

Premium Per Family

N/A

per policy p/m

Monthly Premium 2020
Under 65's

R450

(Age of main insured)
premium per policy p/m

Over 65's

R550

(Age of main insured)
premium per policy p/m

Premium Per Individual

N/A

per policy p/m

Premium Per Family

N/A

per policy p/m

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A full list of 2019 terms and conditions can be viewed here.
A full list of 2020 terms and conditions can be viewed here.

DON'T STRESS! THE INSURANCE GAP IS COVERED.

DON'T STRESS!
THE INSURANCE GAP IS COVERED.

Don’t add financial worry to the stress of being hospitalised.

Never make the mistake of assuming that your medical aid will always cover 100% of your in-hospital expenses. Gap Cover can assist with the additional expenses.

*subject to the aggregate gap cover annual limit of 2019: r158 000 / 2020: R165 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 our Gap Cover policies:

  • Provide benefits for members and their dependants (spouse and/ or child/children up to the age of 25 years only ) 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.
  • May allow for 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 (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).
  • Are not medical aid schemes. The cover is not the same as that of a medical aid scheme. The cover is not a substitute for a medical scheme membership.
  • Are subject to the aggregate gap cover annual limit of R165 000 per insured person per annum. (This limit may change due to regulatory amendment).
  • All of our 2020 product options offer the following TRA ASSIST (powered by ER24 ASSIST) benefits: - Home Drive (now includes Uber) - Panic Button - Medical Health and Trauma Counselling Line NB: Refer to the policy document for the complete list of terms and conditions.