Absolute cover plus - 2019

Premium Per Policy Per Month:

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Individuals

R390 p/m

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Families

R390 p/m

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Over 65’s*

R470 p/m

*age of main insured - for families & individuals

 

 

Absolute cover plus - 2020

Premium Per Policy Per Month:

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Individuals

R450 p/m

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Families

R450 p/m

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Over 65’s*

R550 p/m

*age of main insured - for families & individuals

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.*

Absolute cover plus benefits

Sometimes emergencies occur and you need to rush to casualty.


  • Your medical aid does not always cover the total costs in full. Whether payment comes from your medical scheme savings account or day-to-day benefit, the gap will be covered.
  • Sometimes, your medical aid will not account for anything regarding this casualty visit, leaving you to cover the bill in full.
  • This benefit will cover you for up to 2019: R15 000 / 2020: R20 000 per policy per annum (subject to the annual limit*), EVEN IF YOUR MEDICAL AID COVERS NOTHING.
  • Children under the age of 8 ONLY - May be admitted for any treatment at a casualty unit linked to a hospital between the hours of 7 pm to 7 am from Monday to Friday, from 7 pm on a Friday until 7 am on a Monday, and all day on a public holiday

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.


  • Prosthesis sub-limit: Unlimited but subject to 2019: R158 000 / 2020: R165 000 per insured person per annum. Up to R30 000 per event.
  • MRI / CT / PET scans sub-limit: This benefit provides for 2 MRI, CT or PET scans per policy per annum and up to R4 000 per scan, subject to the annual limit*.
  • No other sub-limits are included in this benefit.

Includes ANY approved costs above annual scheme oncology limit but subject to scheme covering up to this limit. Unlimited per policy per annum but subject to 2019: R158 000 / 2020: R165 000 per insured person per annum.

We often hear of cases where one of our policyholders passes away, leaving their loved  ones to pick up the pieces. They are left with the challenge to make sure that the gap cover they were used to is funded for a period of time.


  • This benefit will provide for your gap cover contributions for a period of 6 months after the death of the original policyholder.

This benefit provides an amount of up to Up to R10 000 per policy per annum.

  • Unlimited per policy per annum but subject to 2019: R158 000 / 2020: R165 000 per insured person per annum.
  • These days most medical aid schemes insist that members pay an upfront amount for certain diagnostic and endoscopic procedures like gastroscopies and colonoscopies.
  • This amount is known as a co-payment or deductible.
  • The amount of times and total you can claim from this Co- Payment benefit is Unlimited (subject to the annual limit*), provided you make use of your medical aid’s designated service provider network.
  • Where a policyholder voluntarily chooses to make use of a service provider that is NOT part of their medical aid’s designated service provider network, this benefit will be limited to 2 co-payment or deductible events per policy per annum, to a combined maximum of R14 000, subject to the annual limit*.
  • The co-payment or deductible that your medical aid charges you for certain in-hospital procedures.
  • This co-payment or deductible is NOT related to the scheme tariff and service provider charge shortfall or designated service provider arrangements.
  • This benefit will cover you for 2 Co-payments per policy per annum up to a combined maximum of R14 000

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

Accidents happen! Unfortunately, some severe accidents may even result in death. The situation is made worse if that person was the main breadwinner. Costs can run into the thousands and often funds are tied up to an estate.


2019

  • This benefit will provide an amount of R8 000 in the event of death of the insured and/or spouse, and R4 000 in the event of the death of the dependant, caused by violent, accidental, external, or visible means.

2020

  • This benefit will provide an amount of R10 000 in the event of death of the insured and/or spouse, and R5 000 in the event of the death of the dependant, caused by violent, accidental, external, or visible means.

2019

  • Benefits: Home Drive, Panic Button, Medical Health Line.
  • Click here for more information.

2020

  • Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line and Claims Submissions.
  • Click here for more information.

*Annual Limit: The Basic Gap, Casualty, Co-Payment, Sub-Limit and Oncology Gap, Co-payment and Extender benefits are subject to the aggregate gap cover annual limit of 2019: R158 000 / 2020: 165 000 per insured person per annum. (This limit may change due to regulatory amendment.)

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

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

Gap cover & prostheses sub-limit example:
Placement of internal prosthesis in 2019

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

Thanks to TRA, the GAP was covered!