*age of main insured - for families & individuals
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.*
Sometimes accidents occur and you need to rush to casualty.
These days most medical aid schemes impose a sub-limit on in-hospital internal prostheses costs. Members may be out of pocket and will have to cover these costs themselves.
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.
These days most medical aid schemes insist that members pay an upfront amount for certain diagnostic and endoscopic procedures like gastroscopies and colonoscopies.
Oncology Gap Benefit: Up to an aggregate of 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 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). Up to R10 000 per policy per annum
Oncology Co-Payment Benefit: Up to R50 000 per policy 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.
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 R5 000 per policy per annum.
*Annual Limit: The Basic Gap, Casualty, Co-Payment, Sub-Limit and Oncology Gap and Co-payment benefits are subject to the aggregate gap cover annual limit of 165 000 per insured person per annum. (This limit may change due to regulatory amendment)
A full list of 2020 terms and conditions can be viewed here.
Your medical aid, just like Sashnee’s, may impose a co-payment on Endoscopic or Laporoscopic Procedures, Hysterectomies as well as Colonoscopies.
Eliminate the financial worry from the stress of a hospital operation or stay.
Terms and conditions apply
