Super cover plus
Premium Per Policy Per Month:
Individuals
R280 p/m
Families
R280 p/m
Over 65’s*
R405 p/m
*age of main insured - for families & individuals
The Super 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.*
Super cover plus benefits
- 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 R12 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
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
- Prosthesis sub-limit: This benefit provides an amount of up to R10 000 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 R3000, subject to the annual limit*.
- Colonoscopies and Gastroscopies: This benefit provides up to R12 000 per policy per annum. Up to R3 000 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 R15 000 in the event of death of the insured and / or spouse, and R5 000 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.
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 R50 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.
- NO cover is 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.
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). R15 000 per policy per annum
Oncology Co-Payment Benefit (In Network): Up to R50 000 per policy per annum
Oncology Co-Payment Benefit (Out Of Network): No 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 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.
- Oncology Extender Benefit: Up to 30 000 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.
- 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 R6 000 (2021) / R10 000 (2022) per policy per annum.
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, apicectomies 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.
co-payment & tariff gap example:
cervical disorder in 2019
Sashnee saved R89 591.78. By choosing Super Cover Plus, you can too.
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
