Absolute Cover Plus is our flagship product which provides Gap cover, Casualty cover, Co-Payment cover and Sub-Limit cover, as well as a separate Oncology benefit that provides Oncology Gap cover, Oncology Co-Payment cover and Oncology Extender cover.
R590 p/m
R590 p/m
R730 p/m
The Absolute Cover Plus option covers up to 700% above medical aid scheme tariff.
This means that if your service provider charges anything up to 7 times what your medical aid will cover, TRA will provide for this GAP, subject to the annual limit.
These days most medical aid schemes impose a sub-limit on in-hospital prostheses costs and some even limit the monetary amount that is available for MRI and CT and PET scans. In both cases, members may be out of pocket and will have to cover these costs themselves.
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 R6 600 per month.
The shortfall between the General Ward Rate and the Private Ward Rate, for hospitalisation for childbirth, where an admission to a Private Ward occurred.
Oncology Co-Payment Benefit:
Oncology Co-Payment Benefit (In Network): Unlimited per policy per annum but subject to R198 660 per insured person per annum.
Oncology Co-Payment Benefit (Out Of Network i.e. voluntary use of a non-designated service provider): 2 co-payments per policy per annum up to a combined limit of R16 000.
Oncology Extender Benefit: Includes ANY approved costs above annual scheme oncology limit but subject to the medical aid scheme covering up to this limit. Unlimited per policy per annum but subject to R198 660 per insured person per annum.
Oncology “New Tech” Benefit: We cover the shortfall / co-payment on new technology oncology treatment (specifically Keytruda®,Xalkori®, Tagrisso®, Yervoy®, Zelboraf®, Imbruvica®). Subject to a medical aid authorised treatment plan and designated service providers being utilised. Up to R16 500 per policy per annum
*Annual Limit: The Basic Gap, Casualty and Oncology Gap benefits 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).
Judy saved R110 316.11. By choosing Absolute Cover Plus, you can too.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Orthopaedic Surgeon
Anaesthetist
Subtotal
Private Rate
R 121 227.71
R 27 642.94
R 148 920.65
Medical Aid Tariff
R 39 143.44
R 11 998.10
R 51 141.54
Gap Cover
R 82 134.27
R 15 644.84
R 97 779.11
Your Share
R 0
R 0
R 0
Medical Aid Sub Limit for Internal Prosthesis
Medical Aid Sub Limit for Internal Prosthesis
Total
R 42 537.00
R 148 920.65
R 30 000.00
R 51 141.54
R 12 537.00
R 110 316.11
R 0
R 0
TERMS AND CONDITIONS APPLY
Judy saved R110 316.11. By choosing Absolute Cover Plus, you can too.
Your medical aid, just like Judy’s, may impose a sub-limit fee for Hip or Knee Replacements, as well as Pacemaker and Stent Operations.
Eliminate the financial worry from the stress of a hospital operation or stay.
TERMS AND CONDITIONS APPLY
Judy saved R110 316.11. By choosing Absolute Cover Plus, you can too.
Your medical aid, just like Judy’s, may impose a sub-limit fee for Hip or Knee Replacements, as well as Pacemaker and Stent Operations.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Orthopaedic Surgeon
Anaesthetist
Subtotal
Private Rate
R 121 227.71
R 27 642.94
R 148 920.65
Medical Aid Tariff
R 39 143.44
R 11 998.10
R 51 141.54
Gap Cover
R 82 134.27
R 15 644.84
R 97 779.11
Your Share
R 0
R 0
R 0
Medical Aid Sub Limit for Internal Prosthesis
Medical Aid Sub Limit for Internal Prosthesis
Total
R 42 537.00
R 148 920.65
R 30 000.00
R 51 141.54
R 12 537.00
R 110 316.11
R 0
R 0
TERMS AND CONDITIONS APPLY
Judy saved R110 316.11. By choosing Absolute Cover Plus, you can too.
Your medical aid, just like Judy’s, may impose a sub-limit fee for Hip or Knee Replacements, as well as Pacemaker and Stent Operations.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Orthopaedic Surgeon
Anaesthetist
Subtotal
Private Rate
R 121 227.71
R 27 642.94
R 148 920.65
Medical Aid Tariff
R 39 143.44
R 11 998.10
R 51 141.54
Gap Cover
R 82 134.27
R 15 644.84
R 97 779.11
Your Share
R 0
R 0
R 0
Medical Aid Sub Limit for Internal Prosthesis
Medical Aid Sub Limit for Internal Prosthesis
Total
R 42 537.00
R 148 920.65
R 30 000.00
R 51 141.54
R 12 537.00
R 110 316.11
R 0
R 0
TERMS AND CONDITIONS APPLY
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.
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:
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.
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.
Navigating medical cover can be challenging, especially when you are preparing for your new addition to the family. One of
The TRA Executive Head for Communications, Public Relations and Training, Warren Gates caught up with Matt Sates slogging it out at the High-Performance Centre at University of Pretoria.
Discrediting common Gap Cover misconceptions with Total Risk Administrators, revealing its crucial role in complementing medical aid.
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Business Estate East
16 Jersey Drive, Longmeadow
Business Estate East
16 Jersey Drive, Longmeadow
Business Estate East
Copyright © 2023. | Terms and Conditions Apply. | Errors and Omissions Excepted.
Copyright © 2023. | Terms and Conditions Apply. | Errors and Omissions Excepted.