A cancer diagnosis can be life-changing, both emotionally and financially. While many medical aid schemes in South Africa provide oncology benefits, patients quickly realise that specialist fees, advanced treatments, and oncology-related co-payments can create a significant financial gap between what their medical aid pays and the actual costs of treatment.
Total Risk Administrators' (TRA) gap cover products are designed to provide additional financial protection against medical aid shortfalls, including qualifying oncology-related expenses.
What Is Oncology Gap Cover?
Gap cover insurance is supplementary insurance that helps cover the difference between what a medical scheme pays and what healthcare professionals charge for approved medical procedures and medical treatment. It is not a substitute for medical aid, but rather works alongside your existing medical aid membership.
When it comes to cancer care, oncology gap cover specifically addresses the shortfalls that can arise during cancer treatment, including specialist consultations, diagnostic scans, and approved oncology treatment plans.
Many medical specialists charge significantly more than the standard medical aid tariff or medical scheme rate, which can leave patients responsible for substantial out-of-pocket expenses. Without adequate protection, these unexpected medical costs can place additional pressure on families already navigating a serious health challenge.
Why Cancer Treatment Can Create Financial Strain
Even comprehensive medical aid plans often include annual oncology limits, sub-limits, and treatment protocols. Once these limits are reached, members may face co-payments, treatment shortfalls or other additional costs.
For example, a specialist may charge several times the scheme rate, while your medical aid covers only a portion of the account. This can result in considerable medical expense shortfall cover needs, especially for long-term oncology care.
In addition, modern oncology treatment may include:
- High-cost biological medications
- Advanced cancer therapies
- PET, CT and MRI scans
- Ongoing specialist consultations
- Extended hospital admissions
- Follow-up care
These expenses can quickly exceed the limits available on a typical medical aid plan.
How TRA Gap Cover Supports Oncology Patients in 2027
TRA Gap Cover offers several oncology-related benefits across selected plans, helping policyholders manage both shortfalls and co-payments associated with approved oncology treatment plans.
1. Oncology Gap Benefit
The Oncology Gap Benefit is available on all TRA Gap Cover plans, including Basic Cover 300, Vital Cover Plus, Super Cover Plus and Absolute Cover Plus. It covers the shortfall that arises when healthcare providers charge above medical scheme tariff for an approved oncology treatment plan.
Cover applies only where the treatment has been authorised by the medical aid, paid up to scheme tariff and remains within the scheme's annual oncology limit.
2. Oncology Co-Payment Benefit
The Oncology Co-Payment Benefit is available on selected plans and helps cover qualifying oncology-related co-payments and treatment contributions required by a medical aid.
This benefit may assist when:
- A medical aid requires a co-payment or deductible for approved oncology treatment.
- A medical aid only covers a percentage of the approved treatment cost.
- Members need assistance with qualifying oncology expenses that remain within the medical scheme's annual oncology limit.
Benefit availability varies by plan:
- Vital Cover Plus: Up to R15,050 per policy per year for qualifying in-network oncology co-payments.
- Super Cover Plus: Up to R69,460 per policy per year for qualifying in-network oncology co-payments, plus one qualifying out-of-network oncology co-payment per policy per year up to R5,790.
- Absolute Cover Plus: Unlimited in-network cover, subject to the aggregate annual limit per insured person, plus up to two qualifying out-of-network oncology co-payments per policy per year with a combined limit of R18,520.
- Basic Cover 300: No oncology co-payment benefit.
3. Oncology Extender Benefit
Cancer treatment can continue after a medical aid's annual oncology benefit has been exhausted. The Oncology Extender Benefit helps cover approved oncology costs above the scheme's annual oncology limit, provided the medical aid has covered treatment up to its oncology limit first.
This benefit is available on:
- Super Cover Plus: Up to R40,520 per policy per year.
- Absolute Cover Plus: Unlimited, subject to the aggregate annual limit per insured person.
The benefit is not available on Basic Cover 300 or Vital Cover Plus.
4. New-Tech Oncology Benefit
Some modern cancer treatments involve innovative, biological or high-cost oncology medications that may create substantial co-payments or shortfalls. TRA's Oncology New-Tech Benefit assists with qualifying shortfalls and co-payments for these treatments, subject to a medical aid-authorised treatment plan and the use of designated service providers.
Benefit availability includes:
- Super Cover Plus: Up to R9,490 per policy per year.
- Absolute Cover Plus: Up to R19,100 per policy per year.
This benefit is not available on Basic Cover 300 or Vital Cover Plus.
5. Diagnostic Scan Benefits
Monitoring and diagnosing cancer often requires advanced imaging such as PET, MRI and CT scans. TRA provides cover for qualifying scan shortfalls where a medical aid's scan sub-limit has been exhausted and the scan has been authorised and paid from the medical aid's in-hospital or major medical benefit.
Available benefits include:
- Super Cover Plus: One MRI, CT or PET scan per policy per year, up to R4,170.
- Absolute Cover Plus: Two MRI, CT or PET scans per policy per year, up to R6,950 per scan.
No scan sub-limit benefit is available on Basic Cover 300 or Vital Cover Plus.
6. Oncology-Related Benefits
For members undergoing breast cancer treatment, selected plans also provide an Oncology Gap Benefit for oncology-related breast reconstruction surgery, including for the unaffected breast, where the procedure forms part of a medical aid-approved oncology treatment plan and remains within the scheme's annual oncology limit.
- Super Cover Plus: Up to R20,840 per beneficiary over the lifetime of the policy.
- Absolute Cover Plus: Up to R40,520 per beneficiary over the lifetime of the policy.
This benefit is not available on Basic Cover 300 or Vital Cover Plus.
7. Additional Female Cancer Cover Product
While TRA Gap Cover helps cover oncology-related treatment shortfalls and co-payments, TRA Female Cancer Cover provides a lump-sum cash payout following the confirmed diagnosis of specified female cancers. This benefit is designed to provide financial support that can be used at the policyholder's discretion, whether for medical expenses, household costs, travel to treatment facilities or loss of income during recovery.
The product provides cover for the following female cancers:
- Breast cancer
- Cervical cancer
- Ovarian cancer
- Uterine cancer
- Cancer of the fallopian tubes
- Vaginal cancer
- Bladder cancer
Each covered cancer type may qualify for a once-off payout per unrelated occurrence, depending on the plan selected.
Benefit levels include:
- Grand: R50,000 per unrelated occurrence
- Supreme: R100,000 per unrelated occurrence
- Ultimate: R150,000 per unrelated occurrence
In addition to female cancer cover, all these plans include an accidental death benefit and access to TRA Assist services, including Home Drive, a panic button service, a medical health and trauma counselling, and digital claims submission.
Comparing Different Gap Cover Plans
When evaluating different gap cover plans, it is important to compare more than just the monthly premium.
The best gap cover options should be assessed according to:
- Oncology benefits
- Annual limits
- Waiting period requirements
- Co payment cover
- Cover for in hospital procedures
- Cover for out of hospital procedures
- Specialist fee shortfalls
- Oncology medication benefits
- Policy exclusions
Gap cover providers, such as TRA, offer cover of up to 700% of the underlying medical aid rate, although benefits and limits vary depending on the product selected.
When comparing gap cover policies, always review the policy documents carefully to understand what is covered and what exclusions may apply.
Understanding Waiting Periods
Many consumers focus on benefits but overlook the importance of the waiting period structure.
Across the market, a month waiting period can range from three to twelve months depending on the product and medical condition.
For TRA Gap Cover policies:
- There is generally no general waiting period of three months on gap cover products.
- Certain conditions are subject to a 10-month condition-specific waiting period.
- A cancer diagnosis prior to joining may trigger a nine-month oncology-related waiting period.
- Claims linked to pre-existing conditions that may lead to hospitalisation are generally subject to a six-month waiting period.
Always review the waiting periods and policy rules before purchasing cover.
Who Should Consider Oncology Gap Cover?
Oncology gap cover may be suitable for individuals who:
- Belong to a registered medical aid scheme
- Want protection against medical aid shortfalls
- Need assistance with oncology-related co payments
- Want comprehensive financial protection against rising treatment costs
- Seek broader cover for specialist fees and approved oncology care
- Want protection against unexpected expenses linked to cancer treatment
Because oncology gap cover requires active medical aid membership, it should always be viewed as complementary cover rather than a replacement for a medical scheme.
Why Consider TRA for oncology gap cover?
Cancer treatment can place significant pressure on finances, even when you belong to a comprehensive medical aid plan. Total Risk Administrators(TRA) has developed a range of gap cover products that include oncology-related benefits, scan benefits, specialist fee shortfall protection, and oncology co-payment cover across selected plans.
For those seeking additional financial protection against oncology-related expenses, TRA Gap Cover has the gap covered!
Note: All material on this website is provided for your information only and may not be construed as medical advice, general advice, or instruction of any kind. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals and/or intermediaries, or other relevant professionals, on any matter relating to their health and overall well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors at the time, and readers who fail to consult with appropriate health and/or financial authorities etc. assume the risk of any injuries and/or liabilities etc. Please note that Gap Cover is not a medical aid, and it is not a substitute for medical aid. Errors and Omissions Excepted. Terms and Conditions Apply.
