Facebook Pixel Gap Cover - Medical Aid Shortfall Cover | Total Risk Administrators

Basic Cover 300

Our entry level product

Standard Benefits

Gap Cover

Casualty Cover

Oncology Gap

Policy Extender

Accidental Death Cover

TRA Assist Powered by ituASSIST

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from R99 p/m
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Vital Cover Plus

Our 2nd entry level product

ALL BASIC COVER BENEFITS PLUS

Co-Payment Cover

Sub-Limit Cover

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from R250 p/m
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Absolute Cover Plus

Our flagship product

ALL SUPER COVER BENEFITS PLUS

Maternity Private Ward Benefit

Oncology Extender Benefits

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from R495 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 R250 p/m
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Super Cover Plus

Our mid-range product

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from R280 p/m
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Absolute Cover Plus

Our flagship product

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from R495 p/m
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Gap Cover Annual Limit

2022
R177 800 in aggregate per insured person per annum* (p/a)

Gap Cover Annual Limit

2022
R177 800 in aggregate per insured person per annum* (p/a)

Gap Cover Annual Limit

2022
R177 800 in aggregate per insured person per annum* (p/a)

Gap Cover Percentage*

300%*

Gap Cover Percentage*

700%*

Gap Cover Percentage*

700%*

PMB's*

Covered, subject to medical aid review

PMB's*

Covered, subject to medical aid review

PMB's*

Covered, subject to medical aid review

Co-payments / deductibles*

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

No Benefit

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)

Unlimited*

Co-payments / deductibles*

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

No Benefit

Co-payments / deductibles*

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

No Benefit

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 R15 000*

CO-PAYMENT BENEFIT*: Out of Hospital/MRI/CT/PET scans

No Benefit

CO-PAYMENT BENEFIT*: Out of Hospital/MRI/CT/PET scans

No Benefit

CO-PAYMENT BENEFIT*: Out of Hospital/MRI/CT/PET scans

2 scans per policy p/a. Unlimited but subject to the aggregate annual limit per insured person p/a*

SUB-LIMITS*: INTERNAL Prostheses

No Benefit

SUB-LIMITS*: INTERNAL Prostheses

Up to R5 000 per policy p/a*

SUB-LIMITS*: INTERNAL Prostheses

Unlimited.* Up to R30 000 per event*

SUB-LIMITS*: MRI / CT / PET Scan

No Benefit

SUB-LIMITS*: MRI / CT / PET Scan

No Benefit

SUB-LIMITS*: MRI / CT / PET Scans

MRI, CT or PET scan up to R5 000 per scan*

SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES

No Benefit

SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES

No Benefit

SUB-LIMITS*: COLONOSCOPIES AND GASTROSCOPIES

Up to R20 000 per insured person per annum

Up to R5 000 per event

CASUALTY UNIT BENEFIT*

Up to R3 000 per policy p/a*

CASUALTY UNIT BENEFIT*

Up to R8 000 per policy p/a*

CASUALTY UNIT BENEFIT*

Up to R20 000 per policy p/a*

GLOBAL FEE BENEFIT*

No Benefit

GLOBAL FEE BENEFIT*

No Benefit

GLOBAL FEE BENEFIT*

Up to R20 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)

Up to an aggregate of R177 800 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)

Up to an aggregate of R177 800 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)

Up to an aggregate of R177 800 per insured person p/a*

Oncology co-payment Benefit (In Network)*

No Benefit

Oncology co-payment Benefit (In Network)*

Up to R10 000 per policy p/a*

Oncology co-payment Benefit (In Network)*

Unlimited*

Oncology co-payment Benefit* (Out of Network)

No Benefit

Oncology co-payment Benefit* (Out of Network)

No Benefit

Oncology co-payment Benefit* (Out of Network)

2 Co-payments per policy per annum up to a combined limit of R15 000

Oncology extender Benefit*

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

No Benefit

Oncology extender Benefit*

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

No Benefit

Oncology extender Benefit*

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

Unlimited*

ONCOLOGY “NEW-TECH” BENEFIT*

No Benefit

ONCOLOGY “NEW-TECH” BENEFIT*

No Benefit

ONCOLOGY “NEW-TECH” BENEFIT*


Up to R15 000 per policy p/a*

ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*

No Benefit

ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*

No Benefit

ONCOLOGY GAP BENEFIT: BREAST RECONSTRUCTION SURGERY*


Up to R30 000 per policy p/a*

MATERNITY PRIVATE WARD BENEFIT*

No Benefit

MATERNITY PRIVATE WARD BENEFIT*

No Benefit

MATERNITY PRIVATE WARD BENEFIT*

Limited to a maximum of R1 000 per day, for a total of 3 consecutive days

Accidental death

Insured / Spouse

R5 000

Accidental death

Insured / Spouse

R7 500

Accidental death

Insured / Spouse

R25 000

Accidental death

Dependant

R2 500

Accidental death

Dependant

R3 750

Accidental death

Dependant

R7 500

Policy Extender

(Additional 12 month gap cover premiums covered upon accidental death of policyholder)

Policy Extender

(Additional 12 month gap cover premiums covered upon accidental death of policyholder)

Policy Extender

(Additional 12 month gap cover premiums covered upon accidental death of policyholder)

DENTAL BENEFIT*

Unlimited but subject to the aggregate annual limit per insured person p/a

DENTAL BENEFIT*

Unlimited but subject to the aggregate annual limit per insured person p/a

DENTAL BENEFIT*

Unlimited but subject to the aggregate annual limit per insured person p/a

TRAVEL BENEFIT

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.

TRAVEL BENEFIT

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.

TRAVEL BENEFIT

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.

TRA ASSIST POWERED BY ituASSIST

Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line (now includes a COVID-19 CARE LINE) and Claims Submissions.

Included

View Monthly Premiums

TRA ASSIST POWERED BY ituASSIST

Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line (now includes a COVID-19 CARE LINE) and Claims Submissions.

Included

View Monthly Premiums

TRA ASSIST POWERED BY ituASSIST

Home Drive (including Uber), Panic Button, Medical Health Line, Trauma Counselling Line (now includes a COVID-19 CARE LINE) and Claims Submissions.

Included

View Monthly Premiums

*subject to an aggregate annual limit of R177 800 per insured person
This limit may be subject to regulatory amendment. Sub-Limits may apply. Refer to the 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. Errors and Omissions Excepted.

A full list of 2022 terms and conditions can be viewed here.

DON'T STRESS! WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES AND WHAT YOUR MEDICAL AID PAYS.

DON'T STRESS!
WE COVER THE GAP BETWEEN WHAT YOUR DOCTOR CHARGES AND WHAT YOUR MEDICAL AID PAYS.

Don’t add financial stress for you and your family if you have to be hospitalised.

Gap Cover is the only way to protect yourself from medical shortfalls. Never assume that your medical aid will always cover 100% of your in-hospital expenses. Gap Cover covers the gap between your hospital expenses and your medical aid shortfalls.

All of our Gap Cover policies:

  • Provide benefits for you and your spouse and those financially dependent on them (child/children and/or aged parents) who are covered on one policy of a registered medical aid scheme. Subject to proof of membership and the premium being based on the age of the oldest beneficiary. Members and their dependants can also be on two different medical aids and one Gap Cover Policy but only 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 gap cover 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 gap 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).
  • Is not a medical aid scheme. Gap cover is not the same as that of a medical aid scheme. Gap cover is not a substitute for your medical aid scheme membership.
  • 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).
  • As of our 2022 product options offer the following TRA ASSIST (powered by ituASSIST) benefits – Home drive – Panic Button - Medical and Trauma Counselling-Line (now includes a COVID- 19 Care Line).

Frequently asked questions

What is Gap Cover?


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.