Vital Cover Plus - Gap Cover | Total Risk Administrators

Vital cover plus

Premium Per Policy Per Month:

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R235 p/m

over-65 icon


R235 p/m

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Over 65’s*

R350 p/m

*age of main insured - for families & individuals

The Vital 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.*

Vital cover plus benefits

    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 the 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 R7 500 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

    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 R5 000 per policy per annum, subject to the annual limit*.
  • No other sub-limits are included in this benefit.

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 R7 500 in the event of death of the insured and / or spouse, and
  • R3 750 in the event of the death of the dependent, 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.

    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 R10 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 R171 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 Co-Payment Benefit: Up to R10 000 per policy per annum

  • 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: No Benefit
  • Breast Reconstruction Surgery: No Benefit
  • Global Fee Benefit: No Benefit

    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 9 months after the accidental death of the original policyholder

The shortfall that arises due to an admission into a Covid-19 Isolation Hotel, based on testing positive for Covid-19.

  • This benefit provides Up to R300 per day for a maximum of 10 days.

*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 R171 000 per insured person per annum. (This limit may change due to regulatory amendment).

A full list of 2021 terms and conditions can be viewed here.

Gap cover example:
spinal surgery in 2019

Ezra saved R 74 569.15. By choosing Vital Cover Plus, you can too.

Your medical aid, just like Ezra’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.

Eliminate the financial worry from the stress of a hospital operation or stay.


Thanks to TRA, the GAP was covered!