Basic Cover 300
Our entry level product
Standard BenefitsGap Cover
Casualty Cover
Oncology Gap
Policy Extender
Accidental Death Cover
TRA Assist Powered by ituASSIST
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Vital Cover Plus
Our 2nd entry level product
ALL BASIC COVER BENEFITS PLUSCo-Payment Cover
Sub-Limit Cover
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Super Cover Plus
Our mid-range product
ALL VITAL COVER BENEFITS PLUSGlobal Fee Benefit
Breast Reconstruction Surgery Benefit
Co-Payment: Out Of Hospital MRI/CT/PET Scans (2022)
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Absolute Cover Plus
Our flagship product
ALL SUPER COVER BENEFITS PLUSMaternity Private Ward Benefit
Oncology Extender Benefits
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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 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%*
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
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)
Up to R50 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)
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
1 MRI / CT / PET scan per policy p/a up to R10 000*
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
Up to R10 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 Scan
1 MRI, CT or PET scan up to
R3 000 per scan*
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 R12 000 per policy per annum
Up to R3 000 per event
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 R12 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 R10 000 per policy p/a*
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 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)*
Up to R50 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)
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)
Up to R30 000 per policy per annum*
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 R7 500 per policy p/a*
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 R15 000 per policy p/a*
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*
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
R15 000
Accidental death
Insured / Spouse
R25 000
Accidental death
Dependant
R2 500
Accidental death
Dependant
R3 750
Accidental death
Dependant
R5 000
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)
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
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.
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 PremiumsTRA 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 PremiumsTRA 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 PremiumsTRA 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.
- 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.
