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Medical Gap insurance waiting periods


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


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:

Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on and matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.


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