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Absolute cover plus

Premium Per Policy Per Month:

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Individuals

R495 p/m

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Families

R495 p/m

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Over 65’s*

R610 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 accidents 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, provided it is for an ACCIDENT, and the treatment provided is at a casualty unit linked to a hospital.
  • 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 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 R185 837 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 R5 000 per scan, subject to the annual limit*.
  • Colonoscopies and Gastroscopies: This Benefit provides up to R20 000 per policy per annum. Up to R5 000 per event, subject to the annual limit.

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 R177 800 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 premiums for a period of 12 months after the accidental death of the original policyholder

Where a global fee has been negotiated between a medical aid and service providers for a specific procedure (which includes ALL costs related to that procedure) and service providers charge amounts in excess of this global fee (not related to a tariff rate, co-payment or sub-limit).

This benefit provides an amount of up to Up to R20 000 per policy per annum.

The shortfall between the General Ward Rate and the Private Ward Rate, for hospitalisation for childbirth, where an admission to a Private Ward occurred.


  • This benefit is limited to a maximum of R1 000 per day, for a total of 3 consecutive days.
  • Unlimited per policy per annum but subject to R177 800
  • 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 R15 000, subject to the annual limit*

Oncology Gap Benefit: Up to an aggregate of R177 800 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 Gap Benefit: Breast Reconstruction Surgery; 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 related breast reconstruction surgery, including the unaffected breast. (NB: Subject to: the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within the annual scheme oncology limit). R30 000 per policy per annum


Oncology Co-Payment Benefit: Unlimited per policy per annum but subject to R171 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.

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.


  • This benefit will provide an amount of R25 000 in the event of death of the insured and/or spouse, and R7 500 in the event of the death of the dependant, caused by violent, accidental, external, or visible means.

  • Benefits: Home Drive, Uber, Panic Button, Medical Health Line, Trauma Counselling Line (including a COVID-19 care line) and Claims Submissions.
  • Click here for more information.

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.

Dental Benefit: Up to an aggregate of R177 800 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 authorised dental procedures performed in hospital or in doctor’s rooms and paid from the in-hospital or major medical benefit only.

The cover is limited to a percentage of the original scheme tariff, as follows:

Adults and dependants over 18 years of age: Treatment of impacted wisdom teeth, extractions, apicoectomies or loss of teeth due to oncology or trauma ONLY.
Dependants up to 18 years of age: Any procedure or treatment.

*Annual Limit: The Basic Gap, Casualty and Oncology Gap benefits are subject to the aggregate gap cover annual limit of R177 800 per insured person per annum. (This limit may change due to regulatory amendment).

A full list of 2022 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

Absolute Cover Plus Savings Table

TERMS AND CONDITIONS APPLY

Absolute Cover Plus Testimonial Image

Thanks to TRA, the GAP was covered!