Super Cover Plus

Applies to authorised in-hospital and in-lieu of hospital procedures, where the medical aid pays a portion of the fees from its in-hospital or major medical benefit. (Includes MRI/ CT/PET scans consumables.)

R3 000 per policy per annum.

Cover for the shortfall on a specialist account related to the consultation in the rooms before a member is going for an in-hospital procedure.

Limited to the following number of consults p.p.p.a (up to a max of R500 per consult).

3 consults per policy per annum.

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 R13 650 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.

Casualty follow-up consultations

(The initial treatment must have taken place in a casualty/ER unit linked to a hospital following an accident.) 

1 follow-up consultation per policy per annum at an ER unit (accident-related only).

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

• Prosthesis sub-limit: This benefit provides an amount of up to R11 550 per policy per annum, subject to the annual limit*.
• This benefit provides for 1 MRI, CT, or PET scan per policy per annum, up to R3 780, subject to the annual limit*.
• Colonoscopies and Gastroscopies: This benefit provides up to R13 650 per policy per annum. Up to R3 780 per event, subject to the annual 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 R21 000 in the event of death of the insured and / or spouse, and R8 400 in the event of the death of the dependant, caused by violent, accidental, external, or visible means.

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

• All TRA Gap Cover policyholders, under the age of 71, have access to the benefit of comprehensive travel insurance which you can read about HERE.
• Benefits include but are not limited to:
  • Emergency Medical and Related expenses: R1 000 000
  • Medical Evacuation, Repatriation or Transportation to a Medical Centre: Actual expense covered when arranged by Hepstar Financial Services.
  • Personal Accident Cover: Death: R25 000 / Permanent Disability: up to R25 000
  • Theft or Accidental Damage during trip: R5 000 / Single item limit: R1 500
  • Theft, Damage or loss by Airline: R5 000 / Single item limit: R1 500
  • Baggage Delay (more that 4 hours): R500
  • Baggage Delay (more that 24 hours): R1 000
• In addition, you may purchase a top-up plan by clicking HERE to increase your medical and baggage related cover, as well as add cover for trip cancellation, pre-existing medical conditions, missed connections and more.
  
  If you are a TRA policyholder, and you need eSIM services, you also have access to a unique link which will take you the SIMTEX website – there, you will Click “Get your eSIM” to purchase your eSIM and data. Your 20% discount will be applied upon checkout! Easy as that. To get your unique link, refer to your year-end email communications from TRA, or contact membership@totalrisksa.co.za.

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
• This benefit will cover you for up to R63 000 per policy per annum (subject to the annual limit*) for co-payment or deductible costs imposed by your medical aid, provided you make use of your medical aid’s designated service provider network.
• Cover provided where a policyholder voluntarily chooses to make use of a service provider that is not part of their medical aid’s service provider network: 1 co-payment per policy per annum. Up to R5 250.
• Co-Payment Benefit: Out of Hospital MRI/CT/PET scans. The co-payment or deductible that your medical aid charges you for MRI / CT / PET scans
  BUT which have been authorised and paid from the In-Hospital or Major Medical benefit. 1 MRI / CT / PET scan per policy per annum up to R12 600.

Oncology Gap Benefit: Up to an aggregate of R210 580 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). R18 900 per policy per annum

Oncology Co-Payment Benefit:

• 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 arrangements.
• 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.

Oncology Co-Payment Benefit (In Network): Up to R63 000 per policy per annum.

Oncology Co-Payment Benefit (Out Of Network i.e. voluntary use of a non-designated service provider): 1 co-payment per policy per annum. Up to R5 250.

Oncology Extender Benefit: Includes ANY approved costs above annual scheme oncology limit but subject to the medical aid scheme covering up to this limit. Up to R36 750 per policy per annum.

Oncology “New Tech” Benefit: We cover the shortfall / co-payment on new technology oncology treatment (specifically Keytruda®,Xalkori®, Tagrisso®, Yervoy®, Zelboraf®, Imbruvica®). Subject to a medical aid authorised treatment plan and designated service providers being utilised. Up to R8 610 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.

• 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 e.g. robotic surgery (which includes ALL costs related to that procedure) and service providers charge mounts in excess of this global fee (not related to a tariff rate, co-payment or sub-limit).

Up to R12 600 per policy per annum.

Dental Benefit: Up to an aggregate of R210 580 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, apicectomies or loss of teeth due to oncology or trauma ONLY.

Dependants up to 18 years of age: Any procedure or treatment.

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

For Childbirth and for Non-Childbirth: Limited to a maximum of R525 per day, for a total of 3 consecutive days.

Provides cover towards a policyholder’s medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed. 6 months. Up to a max. of R5 775. per month.

Cover for the shortfall on a specialist (OBGYN/Paediatrician) account related to a consultation in the rooms within 6 weeks after childbirth. 

Up to R700 per consultation per policy per annum.