Vital Cover Plus is our second entry level product option, which is sufficient in providing for Gap Cover, Casualty cover, Co-Payment cover and Sub-Limit cover, and has a separate Oncology benefit that provides Oncology Gap Cover and Oncology Co-Payment cover. These benefits are subject to an overall annual limit of R158 000 per insured person per annum (or R165 000 per insured person per annum for the year 2020).
Basic Cover/Gap Cover: 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 for in-hospital expenses, TRA will provide for this gap, subject to the annual limit.
Casualty Cover: When an emergency occurs and you need to be rushed to casualty due to an accident, sometimes 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, even if your medical aid covers nothing. This benefit covers up to R5 000 per policy per annum for 2019, and will cover up to R7 500 for 2020.
Co-Payment Cover: Co-Payments are when members have to pay an upfront amount for certain diagnostic and endoscopic procedures, such as gastroscopies and colonoscopies. This amount is known as a co-payment or a deductible. Vital Cover Plus will cover these co-payments, provided you are in your hospital network, for up to R10 000 per policy per annum.
Sub-Limits: 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.The prosthesis sub-limit benefit provides an amount of up to R5 000 per policy per annum, subject to the annual limit. There are no other sub-limits included in this benefit.
Oncology Gap Benefit: Up to an aggregate of 2019: R158 000 / 2020: R165 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.
Additional Benefits:
Accidental Death Cover: 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 R4 000 (2019) or R5 000 (2020) in the event of death of the insured and / or spouse, and R2 000 (2019) or R2 500 (2020) in the event of the death of a dependant, caused by violent, accidental, external, or visible means.
TRA Assist Mobile app: TRA also provides all Gap Cover policyholders with TRA Assist, which is powered by ER24 ASSIST. The benefits include a Home Drive service (which now includes access to Uber trips), a Panic Button and a Medical Health and Trauma Counselling Line.
To find out more information about TRA’s Gap Cover product options, contact your intermediary (who could give you advice on which Gap Cover product option to choose) or go to our website here.
