*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.
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, apicoectomies or loss of teeth due to oncology or trauma ONLY.
Dependants up to 18 years of age: Any procedure or treatment.
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.
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 Co-Payment Benefit (In Network): Up to R10 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.
Benefits include but are not limited to:
*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.
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.
TERMS AND CONDITIONS APPLY
