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Vital cover plus

Premium Per Policy Per Month:

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R250 p/m

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R250 p/m

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Over 65’s*

R370 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.

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.

  • 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 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

  • 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 Co-Payment Benefit (Out Of Network): No Benefit
  • Oncology Extender Benefit: No Benefit
  • Oncology 'New-Tech' Benefit: No Benefit
  • Oncology Gap Benefit - Breast Reconstruction Surgery: No Benefit
  • Maternity Private Ward 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 12 months after the accidental death of the original policyholder

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.

*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.

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.

Vital Cover Plus Savings Table


Vital Cover Plus Testimonial Image

Thanks to TRA, the GAP was covered!