Oncology Gap Benefit: Up to an aggregate of 2019: R158 000 / 2020: R165 000 per insured person per annum. 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 treatment plans (NB: Subject to the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit).
Oncology Co-Payment Benefit: Unlimited per policy per annum but subject to 2019: R158 000 / 2020: R165 000 per insured person per annum.
- The co-payment or deductible that your medical aid charges you for certain in-hospital procedures. This co-payment is NOT related to the scheme tariff and service provider charge shortfall or designated service provider none arrangements, OR
- For claims where the medical aid will only pay a percentage for the approved treatment and the policyholder needs to pay the remaining percentage of the account.
- All costs to be within the annual scheme oncology limit.
- Breast Reconstruction Surgery 2020: Up to R20 000 per policy per annum