Most Medical Gap Insurance policies have general waiting periods before any claims can be processed. Most Gap products will usually apply an approximate 12-month waiting period for pregnancies and other pre-existing conditions. It is important to note that if a membership certificate is provided from a previous Gap Cover provider to prove that your membership has run for at least 12-24 concurrent months with no break in cover, your waiting periods may be waivered.
TRA Gap Cover Waiting Periods:
10-month condition-specific waiting period
Head, neck, and spinal procedures (including stimulators)
All types of hernia procedures
Endoscopic procedures
Pregnancy and childbirth (including caesarean delivery)
Gynaecological conditions
Joint replacement, excluding treatment due to accidental trauma
Inability to walk/move without pain
Any renal, kidney, and bladder conditions
Cardiac
Dentistry (unless due to accidental trauma or oncology)
Cataracts and/or eye laser surgery
Neurological conditions and procedures
Organ transplants
Reconstructive surgery as a result of an accident or condition that occurred prior to membership
Mental health or psychiatric conditions (including depression)
Varicose veins
Oesophagitis, Gastroenteritis, and Gastro-Intestinal Disorders
Male genital system (including prostatectomy)
Carpal Tunnel Syndrome
Any ear, nose, and throat procedures
Diabetes and related conditions
10-month condition-specific waiting period
If a Policyholder is diagnosed with any form of cancer prior to membership, all related claims will be subject to a nine-month waiting period. If a Policyholder has previously been diagnosed with cancer and is currently in remission, the Policyholder needs to advise the Insurer by way of medical evidence that the remission period has been for two or more consecutive years.
Pre-existing medical condition/s waiting period on Gap plan
No claims relating to any pre-existing condition/s that may lead to hospitalisation (excluding cancer) will be covered within the first six months of membership. The Insurer reserves the right to request any clinical information from a Policyholder’s doctor should a claim in this period indicate, and/or relate to, a pre-existing condition.
All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.
Total Risk Administrators offers four different Gap Cover packages to choose from according to your requirements:
Basic Cover 300, starting at R99 p/m
Vital Cover Plus, starting at R220 p/m
Super Cover Plus, starting at R250 p/m
Absolute Cover Plus, starting at R450 p/m
Should you require more information on our Gap coverage, you can have a look at our TRA Gap Cover brochure. For any other queries, contact Total Risk Administrators to speak to one of our specialists today: www.totalrisksa.co.za
